Provider Demographics
NPI:1306399001
Name:PERSONAL TOUCH ACTIVITY CENTER
Entity Type:Organization
Organization Name:PERSONAL TOUCH ACTIVITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-993-1183
Mailing Address - Street 1:PO BOX 87116
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-8116
Mailing Address - Country:US
Mailing Address - Phone:225-993-1183
Mailing Address - Fax:225-667-4998
Practice Address - Street 1:25134 LA HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-6446
Practice Address - Country:US
Practice Address - Phone:225-308-5206
Practice Address - Fax:225-308-5207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15518253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1234Medicaid