Provider Demographics
NPI:1093802936
Name:MEMORIAL HOME HEALTH CARE INC.
Entity Type:Organization
Organization Name:MEMORIAL HOME HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MORAD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:504-234-1011
Mailing Address - Street 1:PO BOX 5610
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70469-5610
Mailing Address - Country:US
Mailing Address - Phone:504-243-1011
Mailing Address - Fax:504-243-1066
Practice Address - Street 1:5640 READ BLVD
Practice Address - Street 2:SUITE 670
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3140
Practice Address - Country:US
Practice Address - Phone:504-243-1011
Practice Address - Fax:504-243-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1400530Medicaid
LA1400530Medicaid