Healthcare Provider Details

I. General information

NPI: 1396038667
Provider Name (Legal Business Name): LOUISIANA GUEST HOUSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 ALBERTSON PKWY
BROUSSARD LA
70518-4971
US

IV. Provider business mailing address

4333 SHREVEPORT HWY
PINEVILLE LA
71360-3828
US

V. Phone/Fax

Practice location:
  • Phone: 337-839-9005
  • Fax: 337-837-9398
Mailing address:
  • Phone: 318-445-6470
  • Fax: 318-641-6282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAC13262
License Number StateLA

VIII. Authorized Official

Name: NICOLE HOWARD
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 318-641-3717