Provider Demographics
NPI:1780764886
Name:PROMISE QUALITY CARE, INC.
Entity type:Organization
Organization Name:PROMISE QUALITY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:B
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:225-926-5300
Mailing Address - Street 1:2035 WOODDALE BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1516
Mailing Address - Country:US
Mailing Address - Phone:225-926-5300
Mailing Address - Fax:225-926-5566
Practice Address - Street 1:2035 WOODDALE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1516
Practice Address - Country:US
Practice Address - Phone:225-926-5300
Practice Address - Fax:225-926-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA124743747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1587915Medicaid
LA1628221Medicaid
LA1595705Medicaid