Provider Demographics
NPI:1659490068
Name:ADVANCED PERSONAL CARE
Entity Type:Organization
Organization Name:ADVANCED PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELOR PSYCHOLOGY
Authorized Official - Phone:337-478-6737
Mailing Address - Street 1:2827 4TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7888
Mailing Address - Country:US
Mailing Address - Phone:337-478-6737
Mailing Address - Fax:
Practice Address - Street 1:2827 4TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7888
Practice Address - Country:US
Practice Address - Phone:337-478-6737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6873251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1714836Medicaid