Healthcare Provider Details

I. General information

NPI: 1033140926
Provider Name (Legal Business Name): MER ROUGE COMMUNITY SVC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 DAVENPORT AVE
MER ROUGE LA
71261
US

IV. Provider business mailing address

1400 DAVENPORT AVE
MER ROUGE LA
71261
US

V. Phone/Fax

Practice location:
  • Phone: 318-647-3691
  • Fax: 318-647-3743
Mailing address:
  • Phone: 318-647-3691
  • Fax: 318-647-3743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SL0600X
TaxonomyLong-Term Care Clinical Nurse Specialist
License Number227
License Number StateLA

VIII. Authorized Official

Name: MRS. SUSAN J MUSGROVE
Title or Position: ADMINISTRATOR
Credential: NFA
Phone: 318-647-3691