Provider Demographics
NPI:1225201007
Name:LOUISIANA HOMECARE OF PLAQUEMINE, LLC
Entity Type:Organization
Organization Name:LOUISIANA HOMECARE OF PLAQUEMINE, LLC
Other - Org Name:LOUISIANA HOMECARE OF PLAQUEMINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:INDEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1307
Mailing Address - Street 1:420 W PINHOOK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2131
Mailing Address - Country:US
Mailing Address - Phone:337-233-1307
Mailing Address - Fax:337-233-5764
Practice Address - Street 1:58604 BELLEVIEW DR
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-3915
Practice Address - Country:US
Practice Address - Phone:225-687-0820
Practice Address - Fax:225-687-1920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1077251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA197181Medicare Oscar/Certification