Healthcare Provider Details

I. General information

NPI: 1457687592
Provider Name (Legal Business Name): NIKKI CHILDREN'S HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2009
Last Update Date: 10/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 7TH ST
LAKE CHARLES LA
70601-6006
US

IV. Provider business mailing address

1621 7TH ST
LAKE CHARLES LA
70601-5570
US

V. Phone/Fax

Practice location:
  • Phone: 337-433-6309
  • Fax:
Mailing address:
  • Phone: 337-433-6309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number StateLA

VIII. Authorized Official

Name: MS. JENNIFER RICHARD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 337-433-6309