Provider Demographics
NPI:1154502334
Name:EEE LLC
Entity type:Organization
Organization Name:EEE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:N
Authorized Official - Last Name:MWAKITAWA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:337-948-9067
Mailing Address - Street 1:333 E PRUDHOMME LN
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6490
Mailing Address - Country:US
Mailing Address - Phone:337-948-9067
Mailing Address - Fax:
Practice Address - Street 1:333 E PRUDHOMME LN
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6490
Practice Address - Country:US
Practice Address - Phone:337-948-9067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EEE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services