Provider Demographics
NPI:1407848898
Name:GUARDIAN HOME HEALTH CARE OF LOUISIANA INC.
Entity Type:Organization
Organization Name:GUARDIAN HOME HEALTH CARE OF LOUISIANA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:PACELLA
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-828-2294
Mailing Address - Street 1:2825 ATHANIA PKWY
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5905
Mailing Address - Country:US
Mailing Address - Phone:504-828-2294
Mailing Address - Fax:504-828-2234
Practice Address - Street 1:2825 ATHANIA PKWY
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5905
Practice Address - Country:US
Practice Address - Phone:504-828-2294
Practice Address - Fax:504-828-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1075251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAXXXXXXXXXXOtherHUMANA /CHOICE CARE NETWORK
LA1406601Medicaid
LA33047OtherBLUE CROSS
LA197758Medicare ID - Type UnspecifiedHOME HEALTH AGENCY