Provider Demographics
NPI:1285254854
Name:A FAMILY AFFAIR ENTERPRISE AGENCY LLC.
Entity type:Organization
Organization Name:A FAMILY AFFAIR ENTERPRISE AGENCY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-588-8058
Mailing Address - Street 1:PO BOX 53552
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70892-3552
Mailing Address - Country:US
Mailing Address - Phone:225-558-8058
Mailing Address - Fax:
Practice Address - Street 1:4652 GLEN OAKS DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811-6023
Practice Address - Country:US
Practice Address - Phone:225-588-8058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2653226Medicaid