Provider Demographics
NPI:1184655318
Name:BAYOU RIVER HEALTH SYSTEMS
Entity Type:Organization
Organization Name:BAYOU RIVER HEALTH SYSTEMS
Other - Org Name:HOUSECALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUELLA
Authorized Official - Middle Name:P
Authorized Official - Last Name:GIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:985-626-4121
Mailing Address - Street 1:2244 11TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1824
Mailing Address - Country:US
Mailing Address - Phone:985-626-2141
Mailing Address - Fax:985-626-4233
Practice Address - Street 1:2244 11TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-1824
Practice Address - Country:US
Practice Address - Phone:985-626-2141
Practice Address - Fax:985-626-4233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA468251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA468AOtherNO BRANCH STATE LICENSE
LA468OtherLA LICENSE NUMBER
LA1403636Medicaid
LA1403636Medicaid