Healthcare Provider Details

I. General information

NPI: 1578560843
Provider Name (Legal Business Name): TOTAL HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 REALTY DR
GRETNA LA
70056-7749
US

IV. Provider business mailing address

444 REALTY DR
GRETNA LA
70056-7749
US

V. Phone/Fax

Practice location:
  • Phone: 504-340-8888
  • Fax: 504-340-2277
Mailing address:
  • Phone: 504-340-8888
  • Fax: 504-340-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number506
License Number StateLA

VIII. Authorized Official

Name: MR. HAROLD E STANLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 504-340-8888