Healthcare Provider Details

I. General information

NPI: 1346485562
Provider Name (Legal Business Name): LOUISIANA HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 WEBB STREET
DETROIT MI
48206-1282
US

IV. Provider business mailing address

1950 WEBB STREET
DETROIT MI
48206-1282
US

V. Phone/Fax

Practice location:
  • Phone: 313-868-8724
  • Fax: 313-883-5023
Mailing address:
  • Phone: 313-868-8724
  • Fax: 313-883-5023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. LILLIA ROSE DODSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: B.A. BUSINESS ADMINI
Phone: 313-868-8724