Provider Demographics
NPI:1346485562
Name:LOUISIANA HOME, INC.
Entity Type:Organization
Organization Name:LOUISIANA HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LILLIA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:BA BUSINESS ADMINI
Authorized Official - Phone:313-868-8724
Mailing Address - Street 1:1950 WEBB STREET
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1282
Mailing Address - Country:US
Mailing Address - Phone:313-868-8724
Mailing Address - Fax:313-883-5023
Practice Address - Street 1:1950 WEBB STREET
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1282
Practice Address - Country:US
Practice Address - Phone:313-868-8724
Practice Address - Fax:313-883-5023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No385H00000XRespite Care FacilityRespite Care