Provider Demographics
NPI:1326326950
Name:IOTA FAMILY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:IOTA FAMILY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:DOUCET
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP/FNP
Authorized Official - Phone:337-275-6915
Mailing Address - Street 1:119 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:IOTA
Mailing Address - State:LA
Mailing Address - Zip Code:70543-6105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:119 SOUTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:IOTA
Practice Address - State:LA
Practice Address - Zip Code:70543
Practice Address - Country:US
Practice Address - Phone:337-275-6915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2364031Medicaid
LA1142701Medicaid