Organization
PREMIER COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIRGINIA COLLINS LCSW (EXECUTIVE DIRECTOR)
(225) 933-0143
Entity
Organization
Contact information
Practice address
105 ROSEBUD STREET, BALDWIN, LA 70514
(337) 923-0505
(337) 923-0363
Mailing address
PO BOX 1009, BALDWIN, LA 70514-1009
(337) 923-0505
(337) 923-0363
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
142861
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1462861
—
LA
01
—
1468261
STATE OF LOUISIANA PERSONAL CARE ATTENDANT AGENCY
LA
Enumeration date
10/22/2014
Last updated
10/29/2014
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