Healthcare Provider Details

I. General information

NPI: 1114250255
Provider Name (Legal Business Name): BEDSIDE HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 MOSS ST STE B
LAFAYETTE LA
70501-1268
US

IV. Provider business mailing address

2900 MOSS ST STE B
LAFAYETTE LA
70501-1268
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number20211
License Number StateLA

VIII. Authorized Official

Name: NORLET TAYLOR SONNIER
Title or Position: ADMINISTRATOR/OWNER
Credential: LPN
Phone: 337-269-5885