Healthcare Provider Details

I. General information

NPI: 1346345519
Provider Name (Legal Business Name): LAFAYETTE HEALTH VENTURES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 A MARTIN ST.
PARKS LA
70582
US

IV. Provider business mailing address

PO BOX 53092
LAFAYETTE LA
70505-3092
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-8977
  • Fax: 337-289-8970
Mailing address:
  • Phone: 337-289-8977
  • Fax: 337-289-8970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN GIBSON
Title or Position: CREDENTIALING
Credential:
Phone: 337-289-8978