Provider Demographics
NPI:1871963801
Name:SPECIAL CARE SERVICES OF LOUISIANA INC
Entity type:Organization
Organization Name:SPECIAL CARE SERVICES OF LOUISIANA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:225-756-4494
Mailing Address - Street 1:PO BOX 77055
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-7055
Mailing Address - Country:US
Mailing Address - Phone:225-756-4494
Mailing Address - Fax:225-756-4495
Practice Address - Street 1:1401 HUDSON LN
Practice Address - Street 2:STE 139
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6068
Practice Address - Country:US
Practice Address - Phone:318-651-0086
Practice Address - Fax:318-651-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203781551251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services