Healthcare Provider Details

I. General information

NPI: 1902809965
Provider Name (Legal Business Name): AGING CARE HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N 2ND ST STE 101
WEST MONROE LA
71291-3253
US

IV. Provider business mailing address

101 N 2ND ST STE 101
WEST MONROE LA
71291-3253
US

V. Phone/Fax

Practice location:
  • Phone: 318-324-9076
  • Fax: 318-324-9088
Mailing address:
  • Phone: 318-324-9076
  • Fax: 318-324-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number420
License Number StateLA

VIII. Authorized Official

Name: MR. OTIS E DAVIS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 318-324-9076