Provider Demographics
NPI:1114123510
Name:COLETTE'S NURSING & HEALTHCARE
Entity Type:Organization
Organization Name:COLETTE'S NURSING & HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:504-305-6130
Mailing Address - Street 1:2100 3RD ST
Mailing Address - Street 2:SUITE#9
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-7600
Mailing Address - Country:US
Mailing Address - Phone:504-305-6130
Mailing Address - Fax:504-305-2377
Practice Address - Street 1:2100 3RD ST
Practice Address - Street 2:SUITE#9
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-7600
Practice Address - Country:US
Practice Address - Phone:504-305-6130
Practice Address - Fax:504-305-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12313313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1408271Medicaid