Healthcare Provider Details

I. General information

NPI: 1952049199
Provider Name (Legal Business Name): MARY LEE'S HOUSE OF LOVE ADULT DAY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 NAPOLEON AVE SUITE B
SUNSET LA
70584
US

IV. Provider business mailing address

PO BOX 1022
SUNSET LA
70584-1022
US

V. Phone/Fax

Practice location:
  • Phone: 337-662-3081
  • Fax:
Mailing address:
  • Phone: 337-662-3081
  • 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: BRANDI LYNN VAUGHNS
Title or Position: ADMINISTRATOR
Credential:
Phone: 337-662-3081