Provider Demographics
NPI:1326222399
Name:1ST CALEBS SIL & PCA RESTORATION INC
Entity Type:Organization
Organization Name:1ST CALEBS SIL & PCA RESTORATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAREE
Authorized Official - Middle Name:TREMAINE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-923-2828
Mailing Address - Street 1:5700 FLORIDA BLVD STE 707
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4280
Mailing Address - Country:US
Mailing Address - Phone:225-923-2828
Mailing Address - Fax:225-923-2829
Practice Address - Street 1:5700 FLORIDA BLVD STE 707
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4280
Practice Address - Country:US
Practice Address - Phone:225-923-2828
Practice Address - Fax:225-923-2829
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1ST CALEBS SIL & PCA RESTORATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1584819Medicaid