Organization
IMMACULATE HEART OF MARY-PCS,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENNETT WADE MORAIN (OWNER)
(337) 290-2775
Entity
Organization
Contact information
Practice address
347 S PRESTON ST, MARKSVILLE, LA 71351-3037
(318) 253-5400
Mailing address
347 S PRESTON ST, P.O. BOX 398, MARKSVILLE, LA 71351-3037
(318) 253-5400
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
PCA 15128
LA
3747P1801X
Personal Care Attendant
Primary
PCA 15128
LA
Other
Enumeration date
11/19/2008
Last updated
11/25/2008
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