Healthcare Provider Details

I. General information

NPI: 1215110788
Provider Name (Legal Business Name): PDI OF THE SOUTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 W PRIEN LAKE RD STE 100
LAKE CHARLES LA
70601-8349
US

IV. Provider business mailing address

710 W PRIEN LAKE RD STE 100
LAKE CHARLES LA
70601-8349
US

V. Phone/Fax

Practice location:
  • Phone: 337-479-0048
  • Fax: 337-479-0685
Mailing address:
  • Phone: 337-479-0048
  • Fax: 337-479-0685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7131
License Number StateLA

VIII. Authorized Official

Name: MS. MARGARET MCCLOSKEY
Title or Position: PRESIDENT
Credential:
Phone: 337-479-0048