Provider Demographics
NPI:1104045269
Name:TUNSON PCA AGENCY LLC
Entity Type:Organization
Organization Name:TUNSON PCA AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:O
Authorized Official - Last Name:TUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-369-7002
Mailing Address - Street 1:120 VICKIE ST
Mailing Address - Street 2:4781 HWY 1
Mailing Address - City:NAPOLEONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70390-8638
Mailing Address - Country:US
Mailing Address - Phone:985-369-7002
Mailing Address - Fax:985-369-7170
Practice Address - Street 1:4781 HWY 1 SOUTH
Practice Address - Street 2:
Practice Address - City:NAPOLEONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70390
Practice Address - Country:US
Practice Address - Phone:985-369-7002
Practice Address - Fax:985-369-7170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 6989311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1509469Medicaid