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General NPI Number Information
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NPI Number | 1619164977
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Entity Type | Organization
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Legal Business Name | LASTING IMPRESSION CARE, INC.
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 2113 SPANISH OAKS DR
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City | HARVEY
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State | LA
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Zip | 70058-3060
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Country | US
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Telephone | 504-227-8343
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Fax | 504-227-8540
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Provider Business Mailing Address
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Address Line | 405 GRETNA BLVD STE 103C
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City | GRETNA
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State | LA
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Zip | 70053-4945
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Country | US
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Telephone | 504-227-8343
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Fax | 504-227-8540
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Authorized Official
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Title or Position | OWNERDIRECTOR
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Name | MRS. TRU'IESHIA ANDERSON-MANARD
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Credential |
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Telephone | 504-494-9246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | SIL20000
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License Number State | LA
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