Basic Information
| Provider Information | |||||||||
| NPI: | 1821336579 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOVING HEARTS RESPITE AND PCA SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10555 LAKE FOREST BLVD STE 9K | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701275233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048215220 | ||||||||
| FaxNumber: | 5048216330 | ||||||||
| Practice Location | |||||||||
| Address1: | 10555 LAKE FOREST BLVD STE 9K | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701275233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048215220 | ||||||||
| FaxNumber: | 5048216330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2013 | ||||||||
| LastUpdateDate: | 01/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | CARTER | ||||||||
| AuthorizedOfficialFirstName: | GAIL | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5048215220 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | RC13074 | LA | Y | Agencies | Day Training, Developmentally Disabled Services |
ID Information
| ID | Type | State | Issuer | Description | 1542482 | 05 | LA | MEDICAID | 1171883 | 05 | LA | MEDICAID |