Provider Demographics
NPI:1073903910
Name:KIDCARE LOUISIANA, LLC
Entity Type:Organization
Organization Name:KIDCARE LOUISIANA, LLC
Other - Org Name:KIDCARE JONESVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDI
Authorized Official - Middle Name:
Authorized Official - Last Name:LOFTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-339-9901
Mailing Address - Street 1:2801 FOURTH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71343-2027
Mailing Address - Country:US
Mailing Address - Phone:318-339-9901
Mailing Address - Fax:318-339-9903
Practice Address - Street 1:2801 FOURTH ST STE 2
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71343
Practice Address - Country:US
Practice Address - Phone:318-339-9901
Practice Address - Fax:318-339-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203783351261QR1300X
LAAP04515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty