Provider Demographics
NPI:1407036015
Name:EEE LLC
Entity Type:Organization
Organization Name:EEE LLC
Other - Org Name:ACTIVEPCA
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:N
Authorized Official - Last Name:MWAKITAWA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:337-948-9067
Mailing Address - Street 1:333 E PRUDHOMME LN
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6490
Mailing Address - Country:US
Mailing Address - Phone:337-948-9067
Mailing Address - Fax:
Practice Address - Street 1:333 E PRUDHOMME LN
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6490
Practice Address - Country:US
Practice Address - Phone:337-948-9067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty