Provider Demographics
NPI:1003003898
Name:LUCI'S TROOP LTC LLC
Entity Type:Organization
Organization Name:LUCI'S TROOP LTC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCI
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. JULIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-234-7031
Mailing Address - Street 1:111 RUBRIA ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-1735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:920 W PINHOOK RD STE 338
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2455
Practice Address - Country:US
Practice Address - Phone:337-234-7031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15070253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1720968Medicaid