Provider Demographics
NPI:1396038667
Name:LOUISIANA GUEST HOUSE, LLC
Entity Type:Organization
Organization Name:LOUISIANA GUEST HOUSE, LLC
Other - Org Name:CAMELOT OF BROUSSARD ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-641-3717
Mailing Address - Street 1:4333 SHREVEPORT HWY
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-3828
Mailing Address - Country:US
Mailing Address - Phone:318-445-6470
Mailing Address - Fax:318-641-6282
Practice Address - Street 1:418 ALBERTSON PKWY
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-4971
Practice Address - Country:US
Practice Address - Phone:337-839-9005
Practice Address - Fax:337-837-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAC13262310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility