MEDICARE: LIL LUS BOOMING ENTERPRISE 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	10031	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	:	1568581460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIL LUS BOOMING ENTERPRISE INC

Provider Business Mailing Address
First Line	:	6201 E SAINT BERNARD HWY
Second Line	:	SUITE E
City	:	VIOLET
State	:	LA
Zip	:	70092-3458
Country	:	US
Telephone Number	:	504-682-2440
Fax Number	:	504-682-6668

Provider Business Practice Location Address
First Line	:	6201 E SAINT BERNARD HWY
Second Line	:	SUITE E
City	:	VIOLET
State	:	LA
Zip	:	70092-3458
Country	:	US
Telephone Number	:	504-682-2440
Fax Number	:	504-682-6668

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. BARBARA MANUEL
Credential	:
Telephone Number	:	504-682-2440

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/22/2020

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