Provider Demographics
NPI:1144475104
Name:PROACTIVE RESOURCES
Entity type:Organization
Organization Name:PROACTIVE RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:SPURLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-328-6800
Mailing Address - Street 1:PO BOX 87356
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-8356
Mailing Address - Country:US
Mailing Address - Phone:225-328-6800
Mailing Address - Fax:
Practice Address - Street 1:6547 N FOSTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811-6115
Practice Address - Country:US
Practice Address - Phone:225-328-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA27029251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1806897Medicaid
LA1803901Medicaid