Organization
IMMACULATE HEART OF MARY-PCS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENNETT MORAIN (OWNER)
(225) 694-3312
Entity
Organization
Contact information
Practice address
241 N LA 1, MORGANZA, LA 70759-3457
(225) 694-3312
(225) 694-0337
Mailing address
PO BOX 505, MORGANZA, LA 70759-0505
(225) 694-3312
(225) 694-0337
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
PCA 7252
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011240
—
LA
Enumeration date
07/05/2007
Last updated
06/17/2008
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