Provider Demographics
NPI:1659576908
Name:HANSBERRY PERSONAL CARE SERVICES, LLC
Entity Type:Organization
Organization Name:HANSBERRY PERSONAL CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CHAISSON
Authorized Official - Last Name:HANSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-662-5944
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:GRAND COTEAU
Mailing Address - State:LA
Mailing Address - Zip Code:70541-0184
Mailing Address - Country:US
Mailing Address - Phone:337-662-5944
Mailing Address - Fax:337-662-5974
Practice Address - Street 1:307 MARTIN LUTHER KING JR. DR.
Practice Address - Street 2:
Practice Address - City:GRAND COTEAU
Practice Address - State:LA
Practice Address - Zip Code:70541
Practice Address - Country:US
Practice Address - Phone:337-662-5944
Practice Address - Fax:337-662-5974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 7255251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPENDINGMedicaid