Healthcare Provider Details

I. General information

NPI: 1134167349
Provider Name (Legal Business Name): INTENSIVE HOME HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 CARTER ST.
VIDALIA LA
71373-3207
US

IV. Provider business mailing address

1633 CARTER ST
VIDALIA LA
71373-3207
US

V. Phone/Fax

Practice location:
  • Phone: 318-336-9030
  • Fax:
Mailing address:
  • Phone: 318-336-9030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1400106
License Number StateLA

VIII. Authorized Official

Name: MS. ARLEVIA C MARTIN
Title or Position: PRESIDENT/CEO
Credential: ADMINISITRATOR
Phone: 318-336-9030