Provider Demographics
NPI:1700230117
Name:PERSONAL PEDIATRIC CARE LLC
Entity Type:Organization
Organization Name:PERSONAL PEDIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRILOUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-362-9553
Mailing Address - Street 1:846 MOUTON ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5889
Mailing Address - Country:US
Mailing Address - Phone:225-362-9553
Mailing Address - Fax:
Practice Address - Street 1:846 MOUTON ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5889
Practice Address - Country:US
Practice Address - Phone:225-362-9553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric