Provider Demographics
NPI:1083661854
Name:A-1 BAYOU HEALTH 2000, INC.
Entity Type:Organization
Organization Name:A-1 BAYOU HEALTH 2000, INC.
Other - Org Name:ALLEGIANCE HOME HEALTH OF SOUTHEAST LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDELON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-226-8202
Mailing Address - Street 1:25420 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-7508
Mailing Address - Country:US
Mailing Address - Phone:985-348-3011
Mailing Address - Fax:985-348-3015
Practice Address - Street 1:826 W HWY 30
Practice Address - Street 2:STE D
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4852
Practice Address - Country:US
Practice Address - Phone:985-348-3011
Practice Address - Fax:985-348-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
LA2203782092251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1403962Medicaid
LA190034432ZOtherBCBS OF LOUISIANA
LA19-7480Medicare PIN