Provider Demographics
NPI:1285245712
Name:LA EXCELCARE
Entity type:Organization
Organization Name:LA EXCELCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DICKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:IDUSUYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-361-0219
Mailing Address - Street 1:4348 S JEFFREY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4196
Mailing Address - Country:US
Mailing Address - Phone:225-361-0219
Mailing Address - Fax:
Practice Address - Street 1:4348 S JEFFREY DR STE 102
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4196
Practice Address - Country:US
Practice Address - Phone:225-361-0219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA EXCEL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA601016816Medicaid