Provider Demographics
NPI:1235132374
Name:LAFAYETTE GENERAL MEDICAL CENTER INC HOME HEALTH
Entity Type:Organization
Organization Name:LAFAYETTE GENERAL MEDICAL CENTER INC HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOODLY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:337-289-8025
Mailing Address - Street 1:201 AUDUBON BLVD
Mailing Address - Street 2:STE 246
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2632
Mailing Address - Country:US
Mailing Address - Phone:337-289-8137
Mailing Address - Fax:337-289-8138
Practice Address - Street 1:201 AUDUBON BLVD
Practice Address - Street 2:STE 246
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2608
Practice Address - Country:US
Practice Address - Phone:337-289-8137
Practice Address - Fax:337-289-8138
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAFAYETTE GENERAL MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-23
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA163251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1401366Medicaid
LA197136Medicare ID - Type Unspecified