Individual ProviderRandi J De La CruzCase Manager/Care CoordinatorOther Service ProvidersPractice Address1102 Commercial Dr, Hammond, LA 70403-5954(985) 662-3799(985) 662-1396PECOS EnrollmentBased on the most recent information from CMS, provider Randi J De La Cruz 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 ID1689285876Provider TypeIndividualFull NameDe La Cruz, Randi JGenderFemaleSole ProprietorNoEnumeration Date8/12/2020Last Updated10/9/2020Contact InformationPractice LocationPractice Address1102 Commercial Dr, Hammond, LA 70403-5954Phone(985) 662-3799Fax(985) 662-3829Mailing LocationMailing Address48374 Barbarita Ln, Tickfaw, LA 70466-4644Phone(985) 662-1396FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted IssuerLouisianaProvider IdentifiersIDDescriptionIssuerID101YOOOOOXDescriptionMedicaidIssuerUnlistedLouisiana