MEDICARE: PRIME CARE NETWORK OF MONROE, LLC

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	251E00000X	Home Health Agency	928	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	:	1851316004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME CARE NETWORK OF MONROE, LLC

Provider Business Mailing Address
First Line	:	3010 LYNDON B JOHNSON FWY STE 1100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-2712
Country	:	US
Telephone Number	:	800-379-1600
Fax Number	:	903-537-8470

Provider Business Practice Location Address
First Line	:	206 E REYNOLDS DR STE D-1
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270-2809
Country	:	US
Telephone Number	:	318-255-2600
Fax Number	:	318-513-1013

Authorized Official
Title or Position	:	DIR LICENSE & REGULATORY COMPLIANCE
Name	:	ANGEL STANSBURY
Credential	:
Telephone Number	:	337-344-2141

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	02/05/2026

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