MEDICARE: MID- STATE HOME HEALTH AGENCY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	354	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124081831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID- STATE HOME HEALTH AGENCY INC

Provider Business Mailing Address
First Line	:	710 VERSAILLES BLVD
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2351
Country	:	US
Telephone Number	:	318-443-9739
Fax Number	:	318-443-9811

Provider Business Practice Location Address
First Line	:	710 VERSAILLES BLVD
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2351
Country	:	US
Telephone Number	:	318-443-9739
Fax Number	:	318-443-9811

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MARK A BROWN
Credential	:	C.P.A
Telephone Number	:	318-443-9739

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	06/27/2008

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Directions to “MID- STATE HOME HEALTH AGENCY INC ” Practice Location

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