Provider Demographics
NPI:1164141859
Name:INTERACTIVE PCA SERVICES
Entity Type:Organization
Organization Name:INTERACTIVE PCA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-453-7377
Mailing Address - Street 1:5876 DELMAR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-2338
Mailing Address - Country:US
Mailing Address - Phone:314-328-1328
Mailing Address - Fax:314-328-1327
Practice Address - Street 1:5876 DELMAR BLVD STE A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-2338
Practice Address - Country:US
Practice Address - Phone:314-328-1038
Practice Address - Fax:314-328-1037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health