Healthcare Provider Details

I. General information

NPI: 1134851405
Provider Name (Legal Business Name): HANSBERRY ADULT DAY HEALTH CARE OF LAFAYETTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 DULLES DR
LAFAYETTE LA
70506-2652
US

IV. Provider business mailing address

2121 DULLES DR
LAFAYETTE LA
70506-2652
US

V. Phone/Fax

Practice location:
  • Phone: 337-484-3221
  • Fax: 337-484-3227
Mailing address:
  • Phone: 337-484-3221
  • Fax: 337-484-3227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY C. HANSBERRY
Title or Position: OWNER/ ADMINISTRATOR
Credential: R.N.
Phone: 337-344-9706