Provider Demographics
NPI:1497940829
Name:PSALMS 23 DME LLC
Entity Type:Organization
Organization Name:PSALMS 23 DME LLC
Other - Org Name:DIVINE INSPIRATION PCA SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:504-366-1302
Mailing Address - Street 1:2701 GEN DEGAULLE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114
Mailing Address - Country:US
Mailing Address - Phone:504-366-1302
Mailing Address - Fax:504-366-1303
Practice Address - Street 1:2701 GEN DEGAULLE DR
Practice Address - Street 2:SUITE C
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114
Practice Address - Country:US
Practice Address - Phone:504-366-1302
Practice Address - Fax:504-366-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1011398Medicaid