Healthcare Provider Details

I. General information

NPI: 1588740583
Provider Name (Legal Business Name): ANGELIC FRIENDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13504 CADIZ DR
BAKER LA
70714-4640
US

IV. Provider business mailing address

4143 SHERWOOD ST
BATON ROUGE LA
70805-4240
US

V. Phone/Fax

Practice location:
  • Phone: 225-355-4411
  • Fax: 225-355-4416
Mailing address:
  • Phone: 225-355-4411
  • Fax: 225-355-4416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1624284
License Number StateLA

VIII. Authorized Official

Name: MRS. CEOLA J. BEAUCHAMP
Title or Position: DIRECTOR/ADMINISTRATOR
Credential:
Phone: 225-775-7804