Provider Demographics
NPI:1487969697
Name:REGIONAL PCA SERVICES - BATON ROUGE, LLC
Entity type:Organization
Organization Name:REGIONAL PCA SERVICES - BATON ROUGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LANPHIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-928-8989
Mailing Address - Street 1:8352 BLUEBONNET BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810
Mailing Address - Country:US
Mailing Address - Phone:225-928-8989
Mailing Address - Fax:225-928-8990
Practice Address - Street 1:138 MCGHEE DRIVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815
Practice Address - Country:US
Practice Address - Phone:225-284-7504
Practice Address - Fax:225-272-0950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA627011261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA627011OtherLICENSE
LA2158368Medicaid