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General NPI Number Information
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NPI Number | 1790807170
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Entity Type | Organization
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Legal Business Name | HAVEN'S GATEWAY PERSONAL CARE FACILITY, INC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 1200 S ACADIAN THRUWAY STE 211
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City | BATON ROUGE
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State | LA
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Zip | 70806-6900
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Country | US
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Telephone | 225-266-2092
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Fax | 225-343-4742
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Provider Business Mailing Address
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Address Line | 1200 S ACADIAN THRUWAY STE 212
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City | BATON ROUGE
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State | LA
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Zip | 70806-6900
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Country | US
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Telephone | 225-226-2092
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Fax | 225-343-4742
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Authorized Official
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Title or Position | PRESIDENT/C.E.O.
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Name | MRS. ALFREDA JACKSON
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Credential | B.A.
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Telephone | 225-343-4741
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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 | SIL 6698
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License Number State | LA
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