Organization
EEE LLC
Active
Other names
ACTIVEPCA
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALICE N MWAKITAWA RN (ADMINISTRATOR)
(337) 948-9067
Entity
Organization
Contact information
Practice address
333 E PRUDHOMME LN, OPELOUSAS, LA 70570-6490
(337) 948-9067
Mailing address
333 E PRUDHOMME LN, OPELOUSAS, LA 70570-6490
(337) 948-9067
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
11/12/2007
Last updated
06/24/2008
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