Provider Demographics
NPI:1750502720
Name:PROMISE PRIDE ENTERPRISES INC
Entity Type:Organization
Organization Name:PROMISE PRIDE ENTERPRISES INC
Other - Org Name:PROMISE PRIDE COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:225-774-3499
Mailing Address - Street 1:5100 GROOM ROAD
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-3124
Mailing Address - Country:US
Mailing Address - Phone:225-774-3385
Mailing Address - Fax:225-774-7381
Practice Address - Street 1:5100 GROOM ROAD
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-3124
Practice Address - Country:US
Practice Address - Phone:225-774-3385
Practice Address - Fax:225-774-7381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA127743747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1468070Medicaid