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General NPI Number Information
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NPI Number | 1497814909
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Entity Type | Organization
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Legal Business Name | SPECIAL CARE SERVICES OF LOUISIANA, INC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 11/10/2007
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Provider Practice Location Address
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Address Line | 128 PLANK ROAD
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City | ST. JOSEPH
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State | LA
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Zip | 71366
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Country | US
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Telephone | 318-766-9396
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Fax | 318-766-9499
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Provider Business Mailing Address
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Address Line | 2142 ONEAL LN SUITE 307
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City | BATON ROUGE
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State | LA
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Zip | 70816-3205
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Country | US
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Telephone | 318-766-9396
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Fax | 318-766-9499
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Authorized Official
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Title or Position | OWNER, DIRECTOR
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Name | MRS. STEPHANIE LAMB ROACH
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Credential | MBA
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Telephone | 225-278-8375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | PCA 14025
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License Number State | LA
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