Provider Demographics
NPI:1386868180
Name:PROMPT SUCCOR NURSING HOME
Entity Type:Organization
Organization Name:PROMPT SUCCOR NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PURSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-948-3634
Mailing Address - Street 1:PO BOX 13524
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-3524
Mailing Address - Country:US
Mailing Address - Phone:318-445-4477
Mailing Address - Fax:
Practice Address - Street 1:954 E PRUDHOMME ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-8239
Practice Address - Country:US
Practice Address - Phone:337-948-3634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1554031Medicaid
LA30087OtherBLUE CROSS BLUE SHIELD
LA30087OtherBLUE CROSS BLUE SHIELD