Individual ProviderCreola L JacqueCase Manager/Care CoordinatorOther Service ProvidersPractice Address1102 Commercial Dr, Hammond, LA 70403-5954(985) 662-3799PECOS EnrollmentBased on the most recent information from CMS, provider Creola L Jacque does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 8 days ago.Profile DetailsProvider ID1306483987Provider TypeIndividualFull NameJacque, Creola LGenderFemaleSole ProprietorNoEnumeration Date12/3/2019Last Updated12/3/2019Contact InformationPractice LocationPractice Address1102 Commercial Dr, Hammond, LA 70403-5954Phone(985) 662-3799Fax(985) 662-3829Mailing LocationMailing Address1102 Commercial Dr, Hammond, LA 70403-5954Phone(985) 662-3799Fax(985) 662-3829Provider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer