Healthcare Provider Details

I. General information

NPI: 1891467221
Provider Name (Legal Business Name): PERSEVERANCE PRIVATE HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6735 HIGHWAY 90 E LOT 20
LAKE CHARLES LA
70615-4792
US

IV. Provider business mailing address

6735 HIGHWAY 90 E LOT 20
LAKE CHARLES LA
70615-4792
US

V. Phone/Fax

Practice location:
  • Phone: 337-263-5924
  • Fax:
Mailing address:
  • Phone: 337-263-5924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DONNA TALBERT
Title or Position: OWNER
Credential:
Phone: 337-263-5924