Healthcare Provider Details

I. General information

NPI: 1790963189
Provider Name (Legal Business Name): BAYOU STATE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 ROBERTSON RD
POLLOCK LA
71467-3800
US

IV. Provider business mailing address

PO BOX 1098
BALL LA
71405-1098
US

V. Phone/Fax

Practice location:
  • Phone: 318-641-9900
  • Fax: 318-641-9991
Mailing address:
  • Phone: 318-641-9900
  • Fax: 318-641-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number810
License Number StateLA

VIII. Authorized Official

Name: MR. ALFRED STEVE COUTEE SR.
Title or Position: OWNER/OPERATOR
Credential:
Phone: 318-641-9900