Basic Information
| Provider Information | |||||||||
| NPI: | 1699020198 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PLAQUEMINES COMMUNITY C.A.R.E. CENTERS FOUNDATION, INC. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 115 KEATING DR | ||||||||
| Address2: | |||||||||
| City: | BELLE CHASSE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700371629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043935750 | ||||||||
| FaxNumber: | 5043935760 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 KEATING DR | ||||||||
| Address2: | |||||||||
| City: | BELLE CHASSE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700371629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043935750 | ||||||||
| FaxNumber: | 5043935760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2012 | ||||||||
| LastUpdateDate: | 07/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | OLSEN | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5043935750 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YP2500X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.