Provider Demographics
NPI:1215014634
Name:MEDICAL ADVANTAGE CARE, L.L.C.
Entity Type:Organization
Organization Name:MEDICAL ADVANTAGE CARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:PROVOST
Authorized Official - Last Name:OLIVIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-269-1629
Mailing Address - Street 1:216 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-7163
Mailing Address - Country:US
Mailing Address - Phone:337-269-1629
Mailing Address - Fax:337-269-1628
Practice Address - Street 1:216 8TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-7163
Practice Address - Country:US
Practice Address - Phone:337-269-1629
Practice Address - Fax:337-269-1628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11345251C00000X
LA11344251C00000X
LA11347251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1188328OtherRESPITE PROVIDER NUMBER
LA1142883OtherSIL PROVIDER NUMBER
LA1188336OtherPCA PROVIDER NUMBER
LA1171824OtherPCS PROVIDER NUMBER