Healthcare Provider Details

I. General information

NPI: 1740741388
Provider Name (Legal Business Name): MARY LEES HOUSE OF LOVE ADULT DAY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 CHURCH STREET
MELVILLE LA
71353
US

IV. Provider business mailing address

403 CHURCH STREET
MELVILLE LA
71353
US

V. Phone/Fax

Practice location:
  • Phone: 337-623-4411
  • Fax:
Mailing address:
  • Phone: 337-623-4411
  • Fax:

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: EUGENIA WASHINGTON
Title or Position: CEO
Credential:
Phone: 337-623-4411