MEDICARE: BAYOU RIVER HEALTH SYSTEMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	468	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	468A	OTHER	LA	NO BRANCH STATE LICENSE
2	468	OTHER	LA	LA LICENSE NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184655318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYOU RIVER HEALTH SYSTEMS

Provider Business Mailing Address
First Line	:	2244 11TH STREET
Second Line	:	SUITE A
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-1824
Country	:	US
Telephone Number	:	985-626-2141
Fax Number	:	985-626-4233

Provider Business Practice Location Address
First Line	:	2244 11TH STREET
Second Line	:	SUITE A
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-1824
Country	:	US
Telephone Number	:	985-626-2141
Fax Number	:	985-626-4233

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. LOUELLA P GIVENS
Credential	:	JD
Telephone Number	:	985-626-4121

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	08/17/2009

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Directions to “BAYOU RIVER HEALTH SYSTEMS ” Practice Location

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