Provider Demographics
NPI:1417945536
Name:VERMILION PARISH HOSPITAL SERVICE DISTRICT #3
Entity Type:Organization
Organization Name:VERMILION PARISH HOSPITAL SERVICE DISTRICT #3
Other - Org Name:GUEYDAN MEMORIAL GUEST HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HENSGENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-536-6584
Mailing Address - Street 1:1201 3RD ST
Mailing Address - Street 2:PO BOX 510
Mailing Address - City:GUEYDAN
Mailing Address - State:LA
Mailing Address - Zip Code:70542-3013
Mailing Address - Country:US
Mailing Address - Phone:337-536-6584
Mailing Address - Fax:337-536-9611
Practice Address - Street 1:1201 3RD ST
Practice Address - Street 2:
Practice Address - City:GUEYDAN
Practice Address - State:LA
Practice Address - Zip Code:70542-3013
Practice Address - Country:US
Practice Address - Phone:337-536-6584
Practice Address - Fax:337-536-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA476314000000X
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1569216Medicaid
LA30158OtherBLUECROSS BLUESHIELD
LA1518409Medicaid
LA195458Medicare Oscar/Certification
LA1569216Medicaid