Provider Demographics
NPI:1285463109
Name:LA GARDERIE ADULT CARE LLC
Entity type:Organization
Organization Name:LA GARDERIE ADULT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LANCIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOKIS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:757-553-7171
Mailing Address - Street 1:805 KNOLLWOOD CT # 2
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3237
Mailing Address - Country:US
Mailing Address - Phone:757-553-7171
Mailing Address - Fax:
Practice Address - Street 1:1604 PROSPECT DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-1732
Practice Address - Country:US
Practice Address - Phone:757-553-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty