Provider Demographics
NPI:1881894681
Name:ENRICH PERSONAL CARE SERVICES, LLC.
Entity type:Organization
Organization Name:ENRICH PERSONAL CARE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-343-3821
Mailing Address - Street 1:7207 DESIARD ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-3914
Mailing Address - Country:US
Mailing Address - Phone:318-343-4964
Mailing Address - Fax:318-343-4965
Practice Address - Street 1:7207 DESIARD ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-3914
Practice Address - Country:US
Practice Address - Phone:318-343-4964
Practice Address - Fax:318-343-4965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7285305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization