Provider Demographics
NPI:1326206251
Name:L A HOMECARE 1 INC
Entity Type:Organization
Organization Name:L A HOMECARE 1 INC
Other - Org Name:LA HOMECARE INC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISRTATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BASIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-320-0779
Mailing Address - Street 1:PO BOX 1647
Mailing Address - Street 2:
Mailing Address - City:NATALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70451-1647
Mailing Address - Country:US
Mailing Address - Phone:985-878-2273
Mailing Address - Fax:985-878-9534
Practice Address - Street 1:15636 HWY 1064
Practice Address - Street 2:
Practice Address - City:NATALBANY
Practice Address - State:LA
Practice Address - Zip Code:70451
Practice Address - Country:US
Practice Address - Phone:985-878-2273
Practice Address - Fax:985-878-9534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1633232251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1633241Medicaid
LA1320382Medicaid
LA1633232Medicaid