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General NPI Number Information
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NPI Number | 1598135683
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Entity Type | Organization
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Legal Business Name | MY PERSONAL CARE ATTENDANT LLC
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 106 CATALPA ST
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City | MONROE
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State | LA
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Zip | 71201-7419
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Country | US
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Telephone | 318-387-3545
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Fax | 318-387-3541
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Provider Business Mailing Address
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Address Line | 106 CATALPA ST
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City | MONROE
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State | LA
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Zip | 71201-7419
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Country | US
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Telephone | 318-387-3545
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Fax | 318-387-3541
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Authorized Official
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Title or Position | OWNER
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Name | MR. RODERICK JENKINS
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Credential |
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Telephone | 318-387-3545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 2203781269
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License Number State | LA
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