=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700052958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GERIATRIC RESOURCES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2008
-----------------------------------------------------
Last Update Date | 12/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6464 CORBINA RD
-----------------------------------------------------
City | LAKE CHARLES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70607-7674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-562-6774
-----------------------------------------------------
Fax | 337-375-0021
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6464 CORBINA RD
-----------------------------------------------------
City | LAKE CHARLES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70607-7674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-562-6774
-----------------------------------------------------
Fax | 337-375-0021
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER-PROVIDER
-----------------------------------------------------
Name | MAUREEN ADRIAN POE
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 337-526-6774
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207QG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------