Healthcare Provider Details

I. General information

NPI: 1508083718
Provider Name (Legal Business Name): REGIONAL PCA SERVICES-NORTHEAST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 NORTH 18TH STREET SUITE 207
MONROE LA
71201
US

IV. Provider business mailing address

8352 BLUEBONNET BLVD
BATON ROUGE LA
70810
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-0471
  • Fax: 318-323-4783
Mailing address:
  • Phone: 225-928-8989
  • Fax: 225-928-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number10481
License Number StateLA

VIII. Authorized Official

Name: MR. CHARLES LANPHIER
Title or Position: OWNER
Credential:
Phone: 225-928-8989