Provider Demographics
NPI:1033141288
Name:GONZALES HOME HEALTH LLC
Entity Type:Organization
Organization Name:GONZALES HOME HEALTH LLC
Other - Org Name:SOUTHERN NURSING HOM HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR. OF LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAUKHUFF JR
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:318-336-9411
Mailing Address - Street 1:7732 GOODWOOD BLVD
Mailing Address - Street 2:SUITE M
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7626
Mailing Address - Country:US
Mailing Address - Phone:225-927-5978
Mailing Address - Fax:225-927-5980
Practice Address - Street 1:7732 GOODWOOD BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-927-5978
Practice Address - Fax:225-927-5978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
LA901251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1405051Medicaid
LA197332Medicare Oscar/Certification
LA9253Medicare PIN