Provider Demographics
NPI:1104222959
Name:PREVENTIVE MEASURES PROGRAMS INC
Entity Type:Organization
Organization Name:PREVENTIVE MEASURES PROGRAMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-574-0098
Mailing Address - Street 1:805 N BEECH ST
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-3809
Mailing Address - Country:US
Mailing Address - Phone:318-574-0098
Mailing Address - Fax:318-574-0066
Practice Address - Street 1:805 N BEECH ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-3809
Practice Address - Country:US
Practice Address - Phone:318-574-0098
Practice Address - Fax:318-574-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1882224302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1649419011Medicaid