Provider Demographics
NPI:1699088567
Name:CARE TEC PEDIATRIC CENTER, LLC
Entity type:Organization
Organization Name:CARE TEC PEDIATRIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAMBETH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:337-301-1029
Mailing Address - Street 1:855 SHIRLEY RD
Mailing Address - Street 2:
Mailing Address - City:BUNKIE
Mailing Address - State:LA
Mailing Address - Zip Code:71322-1540
Mailing Address - Country:US
Mailing Address - Phone:318-346-7337
Mailing Address - Fax:337-346-2339
Practice Address - Street 1:855 SHIRLEY RD
Practice Address - Street 2:
Practice Address - City:BUNKIE
Practice Address - State:LA
Practice Address - Zip Code:71322-1540
Practice Address - Country:US
Practice Address - Phone:318-346-7337
Practice Address - Fax:318-346-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA981103TB0200X
3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, PediatricGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2359908Medicaid