Provider Demographics
NPI:1770686149
Name:PROGRESSIVE ACUTE CARE OAKDALE, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE ACUTE CARE OAKDALE, LLC
Other - Org Name:ELIZABETH FAMILY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:SOILEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-215-3225
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-0629
Mailing Address - Country:US
Mailing Address - Phone:337-639-4390
Mailing Address - Fax:337-639-4030
Practice Address - Street 1:616 COURT ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:LA
Practice Address - Zip Code:70655
Practice Address - Country:US
Practice Address - Phone:337-639-4390
Practice Address - Fax:337-639-4030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSIVE ACUTE CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-07
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1458554Medicaid
LA1458554Medicaid