Provider Demographics
NPI:1619206026
Name:LEMICO
Entity Type:Organization
Organization Name:LEMICO
Other - Org Name:ALTERNATIVE CONCEPT CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-388-2203
Mailing Address - Street 1:3001 ARMAND ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3754
Mailing Address - Country:US
Mailing Address - Phone:318-388-2203
Mailing Address - Fax:318-388-2062
Practice Address - Street 1:3001 ARMAND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3754
Practice Address - Country:US
Practice Address - Phone:318-388-2203
Practice Address - Fax:318-388-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15252305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA=========Medicaid