MEDICARE: FAMILIES IN CONNECTION MINS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251T00000X	PACE Provider Organization	PCA 10948	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730358706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILIES IN CONNECTION MINS, INC

Provider Business Mailing Address
First Line	:	1605 MURRAY ST
Second Line	:	SUITE 105
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-6890
Country	:	US
Telephone Number	:	318-767-0842
Fax Number	:	318-767-2229

Provider Business Practice Location Address
First Line	:	1605 MURRAY ST
Second Line	:	SUITE 105
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-6890
Country	:	US
Telephone Number	:	318-767-0842
Fax Number	:	318-767-2229

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. EUNICE ALFRED
Credential	:
Telephone Number	:	318-767-0842

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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