Basic Information
| Provider Information | |||||||||
| NPI: | 1619204492 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREVENTIVE MEASURES PROGRAMS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9177 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712119177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185740098 | ||||||||
| FaxNumber: | 3185740066 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 N BEECH ST | ||||||||
| Address2: | |||||||||
| City: | TALLULAH | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712823809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185740098 | ||||||||
| FaxNumber: | 3185740066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2009 | ||||||||
| LastUpdateDate: | 10/13/2015 | ||||||||
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| AuthorizedOfficialLastName: | HOLMES | ||||||||
| AuthorizedOfficialFirstName: | CARLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3186145445 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 15154 | LA | N | Agencies | Community/Behavioral Health | 251S00000X | 15250 | LA | N | Agencies | Community/Behavioral Health | 251S00000X | 20123 | LA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1962641076 | 05 | LA | MEDICAID | 1649419011 | 05 | LA | MEDICAID |