Provider Demographics
NPI:1043743081
Name:COMPLETE PERSONAL CARE SERVICES LLC
Entity Type:Organization
Organization Name:COMPLETE PERSONAL CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-380-1613
Mailing Address - Street 1:140 ASPEN SQ STE B
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-5323
Mailing Address - Country:US
Mailing Address - Phone:225-380-1613
Mailing Address - Fax:225-243-4349
Practice Address - Street 1:140 ASPEN SQ STE B
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-5323
Practice Address - Country:US
Practice Address - Phone:225-380-1613
Practice Address - Fax:225-243-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203783218253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1721964Medicaid