Healthcare Provider Details

I. General information

NPI: 1407537624
Provider Name (Legal Business Name): QUANS ADULT DAY PROGRAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4266 W MAIN ST STE 400B
GRAY LA
70359-6421
US

IV. Provider business mailing address

PO BOX 2708
LA PLACE LA
70069-2708
US

V. Phone/Fax

Practice location:
  • Phone: 504-402-7122
  • Fax: 985-651-4613
Mailing address:
  • Phone: 504-402-7122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAQUANA Z MASON
Title or Position: CEO
Credential:
Phone: 504-402-7122