MEDICARE: MONROE AND MAGGIE HOUSE, LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1386460186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONROE AND MAGGIE HOUSE, LLC

Provider Business Mailing Address
First Line	:	2614 HIGHWAY 952
Second Line	:
City	:	JACKSON
State	:	LA
Zip	:	70748-3326
Country	:	US
Telephone Number	:	225-719-8164
Fax Number	:

Provider Business Practice Location Address
First Line	:	2614 HIGHWAY 952
Second Line	:
City	:	JACKSON
State	:	LA
Zip	:	70748-3326
Country	:	US
Telephone Number	:	225-719-8164
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. TYRIE DUNN
Credential	:
Telephone Number	:	225-719-8164

Provider Enumeration Date	:	11/26/2024
Last Update Date	:	11/26/2024

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Directions to “MONROE AND MAGGIE HOUSE, LLC ” Practice Location

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