Healthcare Provider Details

I. General information

NPI: 1093952723
Provider Name (Legal Business Name): SAINT MICHAEL HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W MILLS AVE
BREAUX BRIDGE LA
70517-4805
US

IV. Provider business mailing address

345 W MILLS AVE
BREAUX BRIDGE LA
70517-4805
US

V. Phone/Fax

Practice location:
  • Phone: 337-332-1144
  • Fax:
Mailing address:
  • Phone: 337-332-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberPCA 15153
License Number StateLA

VIII. Authorized Official

Name: MR. VINCENT ALEXANDER
Title or Position: ADMINISTRATOR
Credential:
Phone: 337-332-1144