Healthcare Provider Details

I. General information

NPI: 1619144037
Provider Name (Legal Business Name): MARIE'S FAMILY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E GREEN ST
TALLULAH LA
71282-3823
US

IV. Provider business mailing address

PO BOX 1404
TALLULAH LA
71284-1404
US

V. Phone/Fax

Practice location:
  • Phone: 318-574-9009
  • Fax: 318-574-9926
Mailing address:
  • Phone: 318-574-9009
  • Fax: 318-574-9926

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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number14056
License Number StateLA

VIII. Authorized Official

Name: MATILDA JOHNSON
Title or Position: OWNER/EXEC. DIRECTOR
Credential:
Phone: 318-341-2775