Healthcare Provider Details

I. General information

NPI: 1245345404
Provider Name (Legal Business Name): GOUX ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28119 HIGHWAY 190
LACOMBE LA
70445
US

IV. Provider business mailing address

PO BOX 1429
MANDEVILLE LA
70470-1429
US

V. Phone/Fax

Practice location:
  • Phone: 985-626-1900
  • Fax: 985-727-9660
Mailing address:
  • Phone: 985-626-1900
  • Fax: 985-727-9660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number108
License Number StateLA

VIII. Authorized Official

Name: MRS. MARY LYNN LEACH
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 985-626-1900