Provider Demographics
NPI:1366777559
Name:SPECIAL CARE SERVICES OF LOUISIANA INC
Entity type:Organization
Organization Name:SPECIAL CARE SERVICES OF LOUISIANA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:318-484-7310
Mailing Address - Street 1:PO BOX 77055
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-7055
Mailing Address - Country:US
Mailing Address - Phone:318-484-7310
Mailing Address - Fax:318-484-7374
Practice Address - Street 1:3600 JACKSON STREET EXT
Practice Address - Street 2:STE 119
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3040
Practice Address - Country:US
Practice Address - Phone:318-484-7310
Practice Address - Fax:318-484-7374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 15314302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization