Provider Demographics
NPI:1528192689
Name:SJC SERVICES LLC
Entity Type:Organization
Organization Name:SJC SERVICES LLC
Other - Org Name:DYNAMICCARE HME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:COURVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-984-0123
Mailing Address - Street 1:PO BOX 51738
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1738
Mailing Address - Country:US
Mailing Address - Phone:337-984-0123
Mailing Address - Fax:337-984-5551
Practice Address - Street 1:4551 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-4235
Practice Address - Country:US
Practice Address - Phone:337-984-0123
Practice Address - Fax:337-984-5551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SJC SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1367869Medicaid