Healthcare Provider Details

I. General information

NPI: 1467710608
Provider Name (Legal Business Name): PEDIAKARE DE LOUSIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 MOSS ST
LAFAYETTE LA
70507-4119
US

IV. Provider business mailing address

4011 MOSS ST
LAFAYETTE LA
70507-4119
US

V. Phone/Fax

Practice location:
  • Phone: 337-269-5505
  • Fax: 337-269-5506
Mailing address:
  • Phone: 337-269-5505
  • Fax: 337-269-5506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: MS. SHERITA MARIE NARCISSE
Title or Position: OWNER
Credential:
Phone: 337-269-5505