Healthcare Provider Details

I. General information

NPI: 1386100410
Provider Name (Legal Business Name): ANCHOR OF HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N LAKE ARTHUR AVE UNIT B
JENNINGS LA
70546-4631
US

IV. Provider business mailing address

107 S LAKE ARTHUR AVE STE 6
JENNINGS LA
70546-5766
US

V. Phone/Fax

Practice location:
  • Phone: 337-246-3931
  • Fax: 337-246-3933
Mailing address:
  • Phone: 337-275-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERRI LYNN BOUDREAUX
Title or Position: OWNER
Credential:
Phone: 337-275-1616