Healthcare Provider Details

I. General information

NPI: 1427031582
Provider Name (Legal Business Name): BEAUREGARD MEMORIAL HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PINE ST
DERIDDER LA
70634-4942
US

IV. Provider business mailing address

600 S PINE ST
DERIDDER LA
70634-4942
US

V. Phone/Fax

Practice location:
  • Phone: 337-462-7189
  • Fax: 337-462-7455
Mailing address:
  • Phone: 337-462-7189
  • Fax: 337-462-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number251E00000X
License Number StateLA

VIII. Authorized Official

Name: MS. ROXANA EVETTE VERRETT
Title or Position: OFFICE MANAGER
Credential:
Phone: 337-462-7189