Provider Demographics
NPI:1356454383
Name:ADVANCED PERSONAL CARE, LLC
Entity Type:Organization
Organization Name:ADVANCED PERSONAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:BA - PSYCHOLOGY
Authorized Official - Phone:337-433-6611
Mailing Address - Street 1:726 RYAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-4243
Mailing Address - Country:US
Mailing Address - Phone:337-433-6611
Mailing Address - Fax:337-721-8080
Practice Address - Street 1:726 RYAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-4243
Practice Address - Country:US
Practice Address - Phone:337-433-6611
Practice Address - Fax:337-721-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6895251C00000X
LA6873251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1581852Medicaid