Provider Demographics
NPI:1619201779
Name:SPECIAL CARE SERVICES OF LOUISIANA, INC
Entity Type:Organization
Organization Name:SPECIAL CARE SERVICES OF LOUISIANA, INC
Other - Org Name:PRECISION CAREGIVERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LAMB
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:225-278-8375
Mailing Address - Street 1:2142 ONEAL LN
Mailing Address - Street 2:STE. 307
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3205
Mailing Address - Country:US
Mailing Address - Phone:225-756-4494
Mailing Address - Fax:225-756-4495
Practice Address - Street 1:2380 ONEAL LN
Practice Address - Street 2:STE I
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-9315
Practice Address - Country:US
Practice Address - Phone:225-756-4494
Practice Address - Fax:225-756-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 15301302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPCA 15301Medicaid