Provider Demographics
NPI:1962884221
Name:COMMUNITY PERSONAL CARE SERVICE LLC
Entity type:Organization
Organization Name:COMMUNITY PERSONAL CARE SERVICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-806-9190
Mailing Address - Street 1:123 WESTMARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-7345
Mailing Address - Country:US
Mailing Address - Phone:337-806-9190
Mailing Address - Fax:337-806-9185
Practice Address - Street 1:123 WESTMARK BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-7345
Practice Address - Country:US
Practice Address - Phone:337-806-9190
Practice Address - Fax:337-806-9185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 8677251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1460516Medicaid
LA1166065Medicaid
LA1507091Medicaid
LA1432032Medicaid