Healthcare Provider Details

I. General information

NPI: 1689922874
Provider Name (Legal Business Name): BEDSIDE HOMECARE II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 MOSS ST SUITE B
LAFAYETTE LA
70501-1268
US

IV. Provider business mailing address

2900 MOSS ST SUITE B
LAFAYETTE LA
70501-1268
US

V. Phone/Fax

Practice location:
  • Phone: 337-269-5885
  • Fax: 337-269-5884
Mailing address:
  • Phone: 337-269-5885
  • Fax: 337-269-5884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number15320
License Number StateLA

VIII. Authorized Official

Name: MRS. NORLET TAYLOR PIERRE
Title or Position: OWNER
Credential:
Phone: 337-269-5885