Provider Demographics
NPI:1336291764
Name:MAISON DE'VILLE NURSING HOME, INC.
Entity Type:Organization
Organization Name:MAISON DE'VILLE NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:G
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:225-343-9152
Mailing Address - Street 1:107 S HOLLYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2714
Mailing Address - Country:US
Mailing Address - Phone:985-876-3250
Mailing Address - Fax:985-873-0046
Practice Address - Street 1:107 S HOLLYWOOD RD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2714
Practice Address - Country:US
Practice Address - Phone:985-876-3250
Practice Address - Fax:985-873-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA236314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA51842Medicaid
LA51842Medicaid