Healthcare Provider Details

I. General information

NPI: 1417945536
Provider Name (Legal Business Name): VERMILION PARISH HOSPITAL SERVICE DISTRICT #3
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 3RD ST
GUEYDAN LA
70542-3013
US

IV. Provider business mailing address

1201 3RD ST PO BOX 510
GUEYDAN LA
70542-3013
US

V. Phone/Fax

Practice location:
  • Phone: 337-536-6584
  • Fax: 337-536-9611
Mailing address:
  • Phone: 337-536-6584
  • Fax: 337-536-9611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number476
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateLA

VIII. Authorized Official

Name: CRAIG ROBERT HENSGENS
Title or Position: ADMINISTRATOR
Credential:
Phone: 337-536-6584