Healthcare Provider Details

I. General information

NPI: 1710154463
Provider Name (Legal Business Name): AWESOME KARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7207 DESIARD ST SUITES A & B
MONROE LA
71203-3914
US

IV. Provider business mailing address

7207 DESIARD ST SUITES A & B
MONROE LA
71203-3914
US

V. Phone/Fax

Practice location:
  • Phone: 318-390-4003
  • Fax: 318-390-1702
Mailing address:
  • Phone: 318-390-4003
  • Fax: 318-390-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: LATROYA KANAYE STATEN
Title or Position: OWNER
Credential:
Phone: 318-390-4003