Healthcare Provider Details

I. General information

NPI: 1609066646
Provider Name (Legal Business Name): HOMER MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 EAST COLLEGE ST.
HOMER LA
71040
US

IV. Provider business mailing address

PO BOX 809 620 E COLLEGE ST.
HOMER LA
71040
US

V. Phone/Fax

Practice location:
  • Phone: 318-927-2024
  • Fax: 318-927-9212
Mailing address:
  • Phone: 318-927-2024
  • Fax: 318-972-9212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number206
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number206
License Number StateLA

VIII. Authorized Official

Name: TINA HAYNES
Title or Position: CEO
Credential: RHIA
Phone: 318-927-2024