Organization
JASTAY ENTERPRISES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CYNTHIA FAYE TAYLOR (OWNER)
(318) 556-3378
Entity
Organization
Contact information
Practice address
117 N WASHINGTON ST, BASTROP, LA 71220
(318) 556-3378
(318) 283-5200
Mailing address
117 N WASHINGTON ST, BASTROP, LA 71220
(318) 556-3378
(318) 283-5200
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
10768
LA
251T00000X
PACE Provider Organization
10769
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1438260
PCA
LA
01
—
1453960
CHILDRENS CHOICE
LA
05
—
1470538
—
LA
01
—
1569275
SIL
LA
Enumeration date
05/21/2007
Last updated
08/22/2020
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