Provider Demographics
NPI:1912125139
Name:RELIABLE PCA AGENCY L.L.C
Entity Type:Organization
Organization Name:RELIABLE PCA AGENCY L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:QUENTINA
Authorized Official - Middle Name:LASHELLE
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-340-5306
Mailing Address - Street 1:2380 BARATARIA BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-5459
Mailing Address - Country:US
Mailing Address - Phone:504-340-5306
Mailing Address - Fax:504-328-7677
Practice Address - Street 1:2446 BARATARIA BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-5345
Practice Address - Country:US
Practice Address - Phone:504-340-5306
Practice Address - Fax:504-328-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10218251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1166855Medicaid