# IMMACULATE HEART OF MARY-PCS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831477405
- **Authorized official:** BENNETT WADE MORAIN (OWNER)
- **Authorized official phone:** (337) 623-4100

## Contact information

- **Practice address:** 226 LYONS STREET, MELVILLE, LA 71353
- **Practice address phone:** (337) 623-4100
- **Practice address fax:** (337) 623-4102
- **Mailing address:** P.O. BOX 670, MELVILLE, LA 71353-0670
- **Mailing address phone:** (337) 623-4100
- **Mailing address fax:** (337) 623-4102

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 372500000X | Chore Provider | PCA 12145 | LA | Yes |

## Other

- **Enumeration date:** 07/29/2011
- **Last updated:** 07/29/2011