Healthcare Provider Details

I. General information

NPI: 1770983371
Provider Name (Legal Business Name): PEDIAKARE DE FRANKLIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 HOSPITAL AVE
FRANKLIN LA
70538-3723
US

IV. Provider business mailing address

PO BOX 275
FRANKLIN LA
70538-0275
US

V. Phone/Fax

Practice location:
  • Phone: 504-907-6526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number2203782097
License Number StateLA

VIII. Authorized Official

Name: MR. CRAIG MATHEWS
Title or Position: ADMINISTRATOR
Credential:
Phone: 337-519-2851