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General NPI Number Information
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NPI Number | 1467710608
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Entity Type | Organization
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Legal Business Name | PEDIAKARE DE LOUSIANA
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 4011 MOSS ST
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City | LAFAYETTE
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State | LA
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Zip | 70507-4119
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Country | US
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Telephone | 337-269-5505
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Fax | 337-269-5506
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Provider Business Mailing Address
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Address Line | 4011 MOSS ST
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City | LAFAYETTE
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State | LA
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Zip | 70507-4119
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Country | US
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Telephone | 337-269-5505
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Fax | 337-269-5506
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Authorized Official
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Title or Position | OWNER
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Name | MS. SHERITA MARIE NARCISSE
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Credential |
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Telephone | 337-269-5505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 261QM3000X
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Taxonomy Name | Medically Fragile Infants and Children Day Care
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License Number |
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License Number State |
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