Healthcare Provider Details

I. General information

NPI: 1679737639
Provider Name (Legal Business Name): LAFAYETTE COUNCIL ON AGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 INDUSTRIAL PKWY
LAFAYETTE LA
70508-8309
US

IV. Provider business mailing address

160 INDUSTRIAL PARKWAY
LAFAYETTE LA
70508
US

V. Phone/Fax

Practice location:
  • Phone: 337-262-5990
  • Fax: 337-262-1365
Mailing address:
  • Phone: 337-262-5990
  • Fax: 337-262-1365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number14023
License Number StateLA

VIII. Authorized Official

Name: MR. LARRY W. BAKER
Title or Position: DIRECTOR OF PROGRAMS
Credential:
Phone: 337-262-5990