Provider Demographics
NPI:1982882676
Name:JOSIE B'S AFFECTIONATE CARE PCA
Entity Type:Organization
Organization Name:JOSIE B'S AFFECTIONATE CARE PCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMESETTA
Authorized Official - Middle Name:BUGGAGE
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-713-1647
Mailing Address - Street 1:201C SAINT MARY ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-2634
Mailing Address - Country:US
Mailing Address - Phone:985-713-1647
Mailing Address - Fax:
Practice Address - Street 1:201C SAINT MARY ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2634
Practice Address - Country:US
Practice Address - Phone:985-713-1647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14085251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health