Provider Demographics
NPI:1609038850
Name:MCCORKLE SUNRISE PCA/SIL,LLC
Entity Type:Organization
Organization Name:MCCORKLE SUNRISE PCA/SIL,LLC
Other - Org Name:MCCORKLE SUNRISE,LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GENERAL MANAGER
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:225-288-6931
Mailing Address - Street 1:7185 SCOBELL COURT
Mailing Address - Street 2:SUITE C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1502
Mailing Address - Country:US
Mailing Address - Phone:225-935-2208
Mailing Address - Fax:225-935-2209
Practice Address - Street 1:7262 POINSETTIA DRIVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70812
Practice Address - Country:US
Practice Address - Phone:225-935-2208
Practice Address - Fax:225-935-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 15063372500000X, 3747A0650X
LASIL 20075372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA24Medicaid