Provider Demographics
NPI:1366773632
Name:CHILDRENS SPECIALTY CARE LLC
Entity type:Organization
Organization Name:CHILDRENS SPECIALTY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOUTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-526-0556
Mailing Address - Street 1:1299 TOPSY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-5807
Mailing Address - Country:US
Mailing Address - Phone:337-855-3921
Mailing Address - Fax:
Practice Address - Street 1:1299 TOPSY RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-5807
Practice Address - Country:US
Practice Address - Phone:337-855-3921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies