Healthcare Provider Details

I. General information

NPI: 1841287869
Provider Name (Legal Business Name): OUR LADY OF THE LAKE HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HENNESSY BLVD
BATON ROUGE LA
70808-4375
US

IV. Provider business mailing address

5000 HENNESSY BLVD
BATON ROUGE LA
70808-4375
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-6565
  • Fax: 225-767-1159
Mailing address:
  • Phone: 225-765-6565
  • Fax: 225-767-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT D. DAVIDGE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 225-765-7702