Provider Demographics
NPI:1356612386
Name:CAGE, DAMEKA M
Entity type:Individual
Prefix:
First Name:DAMEKA
Middle Name:M
Last Name:CAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5803 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70812-2642
Mailing Address - Country:US
Mailing Address - Phone:225-733-5515
Mailing Address - Fax:
Practice Address - Street 1:5803 NASHVILLE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70812-2642
Practice Address - Country:US
Practice Address - Phone:225-733-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X, 171WV0202X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171WV0202XOther Service ProvidersContractorVehicle Modifications
No172V00000XOther Service ProvidersCommunity Health Worker