Provider Demographics
NPI:1043472954
Name:KEYS OF LIFE PROFESSIONAL CARE SERVICES INC
Entity Type:Organization
Organization Name:KEYS OF LIFE PROFESSIONAL CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:SOCIAL WORKER
Authorized Official - Phone:504-340-1119
Mailing Address - Street 1:6700 LAPALCO BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-6728
Mailing Address - Country:US
Mailing Address - Phone:504-340-1119
Mailing Address - Fax:504-340-1159
Practice Address - Street 1:6700 LAPALCO BLVD
Practice Address - Street 2:STE A
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-6728
Practice Address - Country:US
Practice Address - Phone:504-340-1119
Practice Address - Fax:504-340-1159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10205251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1170062Medicaid