Healthcare Provider Details

I. General information

NPI: 1457710659
Provider Name (Legal Business Name): EVANGELINE HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 STAGG AVE
BASILE LA
70515-5578
US

IV. Provider business mailing address

8150 N CENTRAL EXPY STE 1800
DALLAS TX
75206-1883
US

V. Phone/Fax

Practice location:
  • Phone: 337-363-5617
  • Fax:
Mailing address:
  • Phone: 469-839-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGIE MARTIN
Title or Position: LICENSING MANAGER
Credential:
Phone: 903-787-7609