Provider Demographics
NPI:1194851006
Name:LIBERTY FOUR COMMUNITY HOME
Entity Type:Organization
Organization Name:LIBERTY FOUR COMMUNITY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANKIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAFLEUR
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:337-363-0228
Mailing Address - Street 1:134 PROGRESS RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-5724
Mailing Address - Country:US
Mailing Address - Phone:337-546-0667
Mailing Address - Fax:337-546-6827
Practice Address - Street 1:134 PROGRESS RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-5724
Practice Address - Country:US
Practice Address - Phone:337-546-0667
Practice Address - Fax:337-546-6827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA294315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1717967OtherPROVIDER NUMBER