Healthcare Provider Details

I. General information

NPI: 1285681171
Provider Name (Legal Business Name): LOUISIANA HOMECARE OF NORTHWEST LOUISIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 JEFFERSON ST
MANSFIELD LA
71052-3201
US

IV. Provider business mailing address

P.O. BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 318-872-0821
  • Fax: 318-871-1884
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-233-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number983
License Number StateLA

VIII. Authorized Official

Name: DONALD D. STELLY
Title or Position: PRESIDENT
Credential:
Phone: 337-233-1307