Healthcare Provider Details

I. General information

NPI: 1073568531
Provider Name (Legal Business Name): CONSOLATA HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 E MAIN ST
NEW IBERIA LA
70560-4031
US

IV. Provider business mailing address

2319 EAST MAIN STREET
NEW IBERIA LA
70560
US

V. Phone/Fax

Practice location:
  • Phone: 337-365-8226
  • Fax: 337-365-8626
Mailing address:
  • Phone: 337-365-8226
  • Fax: 337-365-8626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number147
License Number StateLA

VIII. Authorized Official

Name: MR. DAVID LANDRY
Title or Position: ADMINISTRATOR
Credential:
Phone: 337-365-8226