=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679695902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAYOU INDUSTRIAL MAINTENANCE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2675 4TH ST
-----------------------------------------------------
City | BERWICK
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70342-2835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-384-2003
-----------------------------------------------------
Fax | 985-385-2881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2675 4TH ST
-----------------------------------------------------
City | BERWICK
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70342-2835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-384-2003
-----------------------------------------------------
Fax | 985-385-2881
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. ONEZIPPE (O. JAY) JOSEPH BARBIER
-----------------------------------------------------
Credential | BACHELOR OF SCIENCE
-----------------------------------------------------
Telephone | 985-384-2003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | 2513
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------