Provider Demographics
NPI:1093708349
Name:DEQUINCY HOME HEALTH INC
Entity Type:Organization
Organization Name:DEQUINCY HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATHESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-786-2900
Mailing Address - Street 1:500 SOUTH GRAND AVENUE
Mailing Address - Street 2:PO BOX 1095
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633-3508
Mailing Address - Country:US
Mailing Address - Phone:337-786-1638
Mailing Address - Fax:337-786-2038
Practice Address - Street 1:500 SOUTH GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:DEQUINCY
Practice Address - State:LA
Practice Address - Zip Code:70633-3508
Practice Address - Country:US
Practice Address - Phone:337-786-1638
Practice Address - Fax:337-786-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1036251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1401960Medicaid
LA31245OtherBCBS
LA197520Medicare PIN
LA197520Medicare Oscar/Certification