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General NPI Number Information
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NPI Number | 1144475104
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Entity Type | Organization
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Legal Business Name | PROACTIVE RESOURCES
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 6547 N FOSTER DR SUITE A
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City | BATON ROUGE
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State | LA
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Zip | 70811-6115
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Country | US
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Telephone | 225-328-6800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 87356
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City | BATON ROUGE
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State | LA
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Zip | 70879-8356
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Country | US
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Telephone | 225-328-6800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEREMY DARNELL SPURLOCK
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Credential |
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Telephone | 225-328-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 27029
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License Number State | LA
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