Provider Demographics
NPI:1821254228
Name:ST PAUL COMPANION CARE LLC
Entity Type:Organization
Organization Name:ST PAUL COMPANION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:YUL
Authorized Official - Middle Name:DUBART
Authorized Official - Last Name:LORIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-433-0100
Mailing Address - Street 1:1 LAKESHORE DR STE 1695
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70629-0124
Mailing Address - Country:US
Mailing Address - Phone:337-433-0100
Mailing Address - Fax:337-433-1940
Practice Address - Street 1:1 LAKESHORE DR STE 1695
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70629-0124
Practice Address - Country:US
Practice Address - Phone:337-433-0100
Practice Address - Fax:337-433-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA7221251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1013145Medicaid