Provider Demographics
NPI:1568773299
Name:LUCI,S TROOP LTC LLC
Entity Type:Organization
Organization Name:LUCI,S TROOP LTC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. JULIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-234-7031
Mailing Address - Street 1:111 RUBRIA ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501
Mailing Address - Country:US
Mailing Address - Phone:337-234-7031
Mailing Address - Fax:337-261-0524
Practice Address - Street 1:111 RUBRIA ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-1735
Practice Address - Country:US
Practice Address - Phone:337-234-7031
Practice Address - Fax:337-261-0524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1720968Medicaid