Healthcare Provider Details

I. General information

NPI: 1700052958
Provider Name (Legal Business Name): GERIATRIC RESOURCES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6464 CORBINA RD
LAKE CHARLES LA
70607-7674
US

IV. Provider business mailing address

6464 CORBINA RD
LAKE CHARLES LA
70607-7674
US

V. Phone/Fax

Practice location:
  • Phone: 337-562-6774
  • Fax: 337-375-0021
Mailing address:
  • Phone: 337-562-6774
  • Fax: 337-375-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MAUREEN ADRIAN POE
Title or Position: OWNER-PROVIDER
Credential: APRN
Phone: 337-526-6774