Healthcare Provider Details

I. General information

NPI: 1447524087
Provider Name (Legal Business Name): BETTY JOE'S COMPANION CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24460 HIGHWAY 430
FRANKLINTON LA
70438-2614
US

IV. Provider business mailing address

24460 HIGHWAY 430 P O BOX 247
FRANKLINTON LA
70438-2614
US

V. Phone/Fax

Practice location:
  • Phone: 985-795-9934
  • Fax:
Mailing address:
  • Phone: 985-795-9934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateLA

VIII. Authorized Official

Name: MRS. GYNDLYNN W MAGEE
Title or Position: DIRECTOR
Credential:
Phone: 985-795-9934