Provider Demographics
NPI:1851553689
Name:MER ROUGE COMMUNITY SERVICE INC
Entity Type:Organization
Organization Name:MER ROUGE COMMUNITY SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING BOOKKEEPING
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-647-3691
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:MER ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:71261-0263
Mailing Address - Country:US
Mailing Address - Phone:318-647-3691
Mailing Address - Fax:318-647-3743
Practice Address - Street 1:1400 DAVENPORT AVE
Practice Address - Street 2:
Practice Address - City:MER ROUGE
Practice Address - State:LA
Practice Address - Zip Code:71261-0263
Practice Address - Country:US
Practice Address - Phone:318-647-3691
Practice Address - Fax:318-647-3743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1557871Medicaid
LA1237830001Medicare NSC
LA1557871Medicaid