Provider Demographics
NPI:1376767947
Name:VACHERIE PERSONAL CARE SERVICE, INC
Entity Type:Organization
Organization Name:VACHERIE PERSONAL CARE SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:JESSICA
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-265-2280
Mailing Address - Street 1:154 N HOLLYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-2806
Mailing Address - Country:US
Mailing Address - Phone:985-601-3157
Mailing Address - Fax:985-746-4163
Practice Address - Street 1:154 N HOLLYWOOD RD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-2806
Practice Address - Country:US
Practice Address - Phone:985-601-3157
Practice Address - Fax:985-746-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1983365Medicaid