Provider Demographics
NPI:1760655617
Name:SHARE CARE USA - REGION 5
Entity Type:Organization
Organization Name:SHARE CARE USA - REGION 5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JO LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONCRIEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-406-8228
Mailing Address - Street 1:PO BOX 51887
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1887
Mailing Address - Country:US
Mailing Address - Phone:337-406-8228
Mailing Address - Fax:337-406-8393
Practice Address - Street 1:1717 E PRIEN LAKE RD STE 8
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-0400
Practice Address - Country:US
Practice Address - Phone:337-406-8228
Practice Address - Fax:337-406-8393
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHARE CARE USA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-10
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services