=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659690527
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRIBOC PERSONAL CARE ASSISTANCE SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2010
-----------------------------------------------------
Last Update Date | 05/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 323 PLUM ST
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71202-2605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-388-2090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 807
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71210-0807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-388-2090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. JUNE M LENGYON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 318-388-2090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------