Provider Demographics
NPI:1548410426
Name:MCCORKLE SUNRISE PCA/SIL,LLC
Entity Type:Organization
Organization Name:MCCORKLE SUNRISE PCA/SIL,LLC
Other - Org Name:MCCORKLE SUNRISE
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL MASNASGER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCCORKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-935-2208
Mailing Address - Street 1:2036 WOODDALE BLVD
Mailing Address - Street 2:SUITE M
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1518
Mailing Address - Country:US
Mailing Address - Phone:225-935-2208
Mailing Address - Fax:225-935-2209
Practice Address - Street 1:7262 POINSETTIA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70812-1861
Practice Address - Country:US
Practice Address - Phone:225-288-6931
Practice Address - Fax:225-935-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health