Healthcare Provider Details

I. General information

NPI: 1811154560
Provider Name (Legal Business Name): DFALLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 NEWSON ST
RAYVILLE LA
71269-3056
US

IV. Provider business mailing address

213 NEWSON ST
RAYVILLE LA
71269-3056
US

V. Phone/Fax

Practice location:
  • Phone: 318-728-3488
  • Fax: 318-728-1065
Mailing address:
  • Phone: 318-728-3488
  • Fax: 318-728-3478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberPCA 15205
License Number StateLA

VIII. Authorized Official

Name: ZENOBIA FRANCINE DAVISON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 318-728-3488