Provider Demographics
NPI:1447894787
Name:ILES, LARRICA
Entity type:Individual
Prefix:MS
First Name:LARRICA
Middle Name:
Last Name:ILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 KEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-0030
Mailing Address - Country:US
Mailing Address - Phone:318-238-4030
Mailing Address - Fax:
Practice Address - Street 1:217 BREVARD CT STE B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3997
Practice Address - Country:US
Practice Address - Phone:318-238-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant