Healthcare Provider Details

I. General information

NPI: 1093708349
Provider Name (Legal Business Name): DEQUINCY HOME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SOUTH GRAND AVENUE
DEQUINCY LA
70633-3508
US

IV. Provider business mailing address

500 SOUTH GRAND AVENUE PO BOX 1095
DEQUINCY LA
70633-3508
US

V. Phone/Fax

Practice location:
  • Phone: 337-786-1638
  • Fax: 337-786-2038
Mailing address:
  • Phone: 337-786-1638
  • Fax: 337-786-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1036
License Number StateLA

VIII. Authorized Official

Name: MR. JOHN A MATHESON
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 337-786-2900