Healthcare Provider Details

I. General information

NPI: 1154790541
Provider Name (Legal Business Name): TRUCARE TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 HICKORY ST
PINEVILLE LA
71360-6735
US

IV. Provider business mailing address

124 HICKORY ST
PINEVILLE LA
71360-6735
US

V. Phone/Fax

Practice location:
  • Phone: 318-791-2116
  • Fax:
Mailing address:
  • Phone: 318-791-2116
  • Fax: 318-487-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number3205100102015
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3205100102015
License Number StateLA

VIII. Authorized Official

Name: MR. CLAUDE JOSEPH SMITH
Title or Position: OWNER
Credential:
Phone: 318-791-2116