Provider Demographics
NPI:1508043449
Name:QUALITY PERSONAL CARE SERVICE
Entity Type:Organization
Organization Name:QUALITY PERSONAL CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MONETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-926-3337
Mailing Address - Street 1:7395 EXCHANGE PLACE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806
Mailing Address - Country:US
Mailing Address - Phone:225-926-3337
Mailing Address - Fax:225-926-3338
Practice Address - Street 1:7395 EXCHANGE PLACE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-926-3337
Practice Address - Fax:225-926-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1479136164W00000X
LA14766093747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1479136Medicaid