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General NPI Number Information
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NPI Number | 1033361860
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Entity Type | Organization
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Legal Business Name | L A HOMECARE 1 INC
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Dates
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Enumeration Date | 10/10/2008
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 146 HWY 40 SUITE C
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City | INDEPENDENCE
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State | LA
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Zip | 70443
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Country | US
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Telephone | 985-878-2273
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Fax | 985-878-9534
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Provider Business Mailing Address
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Address Line | PO BOX 1647
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City | NATALBANY
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State | LA
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Zip | 70451-1647
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Country | US
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Telephone | 985-878-2273
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Fax | 985-878-9534
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. BASIEL WILLIAMS
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Credential |
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Telephone | 985-878-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | SIL20076
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License Number State | LA
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