Provider Demographics
NPI:1588806160
Name:A PEACE OF MIND CARE PROVIDERS, INC.
Entity Type:Organization
Organization Name:A PEACE OF MIND CARE PROVIDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:TARASA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:SW
Authorized Official - Phone:504-220-7845
Mailing Address - Street 1:116 OAK LN
Mailing Address - Street 2:B
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-2128
Mailing Address - Country:US
Mailing Address - Phone:985-785-4451
Mailing Address - Fax:985-785-4459
Practice Address - Street 1:116 OAK LN
Practice Address - Street 2:B
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-2128
Practice Address - Country:US
Practice Address - Phone:985-785-4451
Practice Address - Fax:985-785-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20142253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20142Medicaid