Basic Information
| Provider Information | |||||||||
| NPI: | 1780160390 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECIAL CARE SERVICES OF LOUISIANA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14241 COURSEY BLVD BLDG A12-268 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708171368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186510086 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1401 HUDSON LN STE 135 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712016037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186510086 | ||||||||
| FaxNumber: | 3186510087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2018 | ||||||||
| LastUpdateDate: | 07/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | LAMB | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3186510086 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 2203783817 | LA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | BH0012231 | 05 | LA | MEDICAID |