Provider Demographics
NPI:1598135683
Name:MY PERSONAL CARE ATTENDANT LLC
Entity type:Organization
Organization Name:MY PERSONAL CARE ATTENDANT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-387-3545
Mailing Address - Street 1:106 CATALPA ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7419
Mailing Address - Country:US
Mailing Address - Phone:318-387-3545
Mailing Address - Fax:318-387-3541
Practice Address - Street 1:106 CATALPA ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7419
Practice Address - Country:US
Practice Address - Phone:318-387-3545
Practice Address - Fax:318-387-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203781269253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1140473Medicaid
LA1031658Medicaid
LA2327135Medicaid