Provider Demographics
NPI:1194852756
Name:PROFESSIONAL PERSONAL CARE SERVICES INC
Entity Type:Organization
Organization Name:PROFESSIONAL PERSONAL CARE SERVICES INC
Other - Org Name:PROFESSIONAL PERSONAL CARE SERVICES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:ST JULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-560-4049
Mailing Address - Street 1:136 CENTER ST # A
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3706
Mailing Address - Country:US
Mailing Address - Phone:337-560-4049
Mailing Address - Fax:337-560-5343
Practice Address - Street 1:136 CENTER ST # A
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3706
Practice Address - Country:US
Practice Address - Phone:337-560-4049
Practice Address - Fax:337-560-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1623873OtherPROVIDER NUMBER SIL