Provider Demographics
NPI:1376796201
Name:SOLECARE, L.L.C.
Entity Type:Organization
Organization Name:SOLECARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:STEWART-DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:318-325-0325
Mailing Address - Street 1:2803 EVANGELINE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3749
Mailing Address - Country:US
Mailing Address - Phone:318-325-0325
Mailing Address - Fax:
Practice Address - Street 1:2803 EVANGELINE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3749
Practice Address - Country:US
Practice Address - Phone:504-606-0217
Practice Address - Fax:318-325-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1141283Medicaid
LA1141283Medicaid
LAQ21373Medicare UPIN