Provider Demographics
NPI:1154816908
Name:LAUVES PPECC LLC
Entity Type:Organization
Organization Name:LAUVES PPECC LLC
Other - Org Name:LAUVE'S PEDIATRIC EXTENDED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:LAUVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-465-5494
Mailing Address - Street 1:435 MONROVIA ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-1607
Mailing Address - Country:US
Mailing Address - Phone:318-465-5494
Mailing Address - Fax:318-741-5757
Practice Address - Street 1:403 ENTERPRISE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-5463
Practice Address - Country:US
Practice Address - Phone:318-465-5494
Practice Address - Fax:318-383-1215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4017402-01Medicaid