Provider Demographics
NPI:1568793461
Name:REGIONAL PCA SERVICES - NORTHEAST, LLC
Entity Type:Organization
Organization Name:REGIONAL PCA SERVICES - NORTHEAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-928-8989
Mailing Address - Street 1:101 N 2ND ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-3266
Mailing Address - Country:US
Mailing Address - Phone:318-654-4150
Mailing Address - Fax:318-654-4160
Practice Address - Street 1:101 N 2ND ST
Practice Address - Street 2:SUITE 114
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-3266
Practice Address - Country:US
Practice Address - Phone:318-654-4150
Practice Address - Fax:318-654-4160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15293253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care