Healthcare Provider Details

I. General information

NPI: 1043907991
Provider Name (Legal Business Name): MSGR. DEBLANC - DAUGHTERS OF MARY MOTHER OF MERCY JOY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 7TH ST
LAKE CHARLES LA
70601-6006
US

IV. Provider business mailing address

425 7TH ST
LAKE CHARLES LA
70601-6006
US

V. Phone/Fax

Practice location:
  • Phone: 862-371-5775
  • Fax:
Mailing address:
  • Phone: 862-371-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State

VIII. Authorized Official

Name: CHIBUJUM EJIOCHI SR.
Title or Position: ASSISTANT MANAGER OR
Credential: REGISTERED NURSE
Phone: 337-496-6575