Healthcare Provider Details

I. General information

NPI: 1144210485
Provider Name (Legal Business Name): BAYOU HOME CARE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 CIVIC CENTER BLVD
HOUMA LA
70360
US

IV. Provider business mailing address

8150 N CENTRAL EXPY STE 1800
DALLAS TX
75206-1883
US

V. Phone/Fax

Practice location:
  • Phone: 985-580-2270
  • Fax: 985-580-2202
Mailing address:
  • Phone: 469-839-3777
  • Fax: 469-983-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1010
License Number StateLA

VIII. Authorized Official

Name: ANGIE MARTIN
Title or Position: LICENSING & CREDENTIALING
Credential:
Phone: 903-787-7609