Provider Demographics
NPI:1114250255
Name:BEDSIDE HOMECARE, LLC
Entity Type:Organization
Organization Name:BEDSIDE HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORLET
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:SONNIER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:337-269-5885
Mailing Address - Street 1:2900 MOSS ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-1268
Mailing Address - Country:US
Mailing Address - Phone:337-269-5885
Mailing Address - Fax:
Practice Address - Street 1:2900 MOSS ST STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-1268
Practice Address - Country:US
Practice Address - Phone:337-269-5885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20211320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20211Medicaid