Provider Demographics
NPI:1811228729
Name:REGIONAL PCA SERVICES - SOUTHEAST, LLC
Entity Type:Organization
Organization Name:REGIONAL PCA SERVICES - SOUTHEAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-928-8989
Mailing Address - Street 1:902 C M FAGAN DR
Mailing Address - Street 2:SUITE A SHAMOCK PLAZA
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-6043
Mailing Address - Country:US
Mailing Address - Phone:985-747-1994
Mailing Address - Fax:985-747-1965
Practice Address - Street 1:902 C M FAGAN DR
Practice Address - Street 2:SUITE A SHAMOCK PLAZA
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-6043
Practice Address - Country:US
Practice Address - Phone:985-747-1994
Practice Address - Fax:985-747-1965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15326253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care