Healthcare Provider Details

I. General information

NPI: 1093629198
Provider Name (Legal Business Name): LIVING OUT DREAMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 COUGAR DR
HOUMA LA
70360-7362
US

IV. Provider business mailing address

453 COUGAR DR
HOUMA LA
70360-7362
US

V. Phone/Fax

Practice location:
  • Phone: 225-249-2494
  • Fax:
Mailing address:
  • Phone: 225-249-2494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEKEYSHA CARTER
Title or Position: OWNER
Credential:
Phone: 225-249-2494