Provider Demographics
NPI:1447474135
Name:ST. GENEVIVE HEALTH CARE SERVICES, INC.
Entity type:Organization
Organization Name:ST. GENEVIVE HEALTH CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-219-4101
Mailing Address - Street 1:3644 GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71302-3324
Mailing Address - Country:US
Mailing Address - Phone:318-443-4141
Mailing Address - Fax:
Practice Address - Street 1:3644 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-3324
Practice Address - Country:US
Practice Address - Phone:318-443-4141
Practice Address - Fax:318-443-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 7097320900000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1458716Medicaid