Provider Demographics
NPI:1467710608
Name:PEDIAKARE DE LOUSIANA
Entity Type:Organization
Organization Name:PEDIAKARE DE LOUSIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERITA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NARCISSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-269-5505
Mailing Address - Street 1:900 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-1371
Mailing Address - Country:US
Mailing Address - Phone:337-269-5505
Mailing Address - Fax:337-269-5506
Practice Address - Street 1:900 WALKER RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-1371
Practice Address - Country:US
Practice Address - Phone:337-269-5505
Practice Address - Fax:337-269-5506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center