Provider Demographics
NPI:1699101675
Name:PEDIATRUST, LLC
Entity type:Organization
Organization Name:PEDIATRUST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-252-7633
Mailing Address - Street 1:2041 FLORIDA BLVD SW
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726
Mailing Address - Country:US
Mailing Address - Phone:225-665-7287
Mailing Address - Fax:
Practice Address - Street 1:2041 FLORIDA AVE SW
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4914
Practice Address - Country:US
Practice Address - Phone:225-665-7287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIARUST, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-23
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric