Healthcare Provider Details

I. General information

NPI: 1174777288
Provider Name (Legal Business Name): SPECIAL CARE SERVICES OF LOUISIANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 PLANK RD
ST JOSEPH LA
71366
US

IV. Provider business mailing address

2142 ONEAL LN SUITE 307
BATON ROUGE LA
70816-3205
US

V. Phone/Fax

Practice location:
  • Phone: 318-766-9396
  • Fax: 318-766-9499
Mailing address:
  • Phone: 225-278-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number14025
License Number StateLA

VIII. Authorized Official

Name: STEPHANIE LAMB ROACH
Title or Position: DIRECTOR
Credential: MBA
Phone: 225-278-8375