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General NPI Number Information
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NPI Number | 1497187637
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Entity Type | Organization
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Legal Business Name | AUDUBON HOME HEALTH SOUTH INC
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Dates
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Enumeration Date | 07/30/2013
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 221 RUE DE JEAN STE 201
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City | LAFAYETTE
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State | LA
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Zip | 70508-3283
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Country | US
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Telephone | 337-210-5124
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Fax | 337-456-4751
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Provider Business Mailing Address
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Address Line | 9256 INTERLINE AVE
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City | BATON ROUGE
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State | LA
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Zip | 70809-1907
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Country | US
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Telephone | 225-218-8009
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Fax | 225-237-1170
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Authorized Official
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Title or Position | OWNER
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Name | MR. RAYMOND W BANKER JR.
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Credential | RN
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Telephone | 225-218-8009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 2203781731
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License Number State | LA
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