Provider Demographics
NPI:1417144734
Name:BAYOU HOME BUREAU CORP
Entity Type:Organization
Organization Name:BAYOU HOME BUREAU CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-556-0043
Mailing Address - Street 1:8057 WILLIARD RD
Mailing Address - Street 2:P. O. BOX 561
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-8939
Mailing Address - Country:US
Mailing Address - Phone:318-556-0043
Mailing Address - Fax:318-556-3633
Practice Address - Street 1:8057 WILLIARD RD
Practice Address - Street 2:SAME
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-8939
Practice Address - Country:US
Practice Address - Phone:318-556-0043
Practice Address - Fax:318-556-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1564761251T00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization