Provider Demographics
NPI:1427045020
Name:LAFOURCHE HOME FOR THE AGED & INFIRM, INC.
Entity Type:Organization
Organization Name:LAFOURCHE HOME FOR THE AGED & INFIRM, INC.
Other - Org Name:LAFOURCHE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-447-2205
Mailing Address - Street 1:1002 TIGER DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6634
Mailing Address - Country:US
Mailing Address - Phone:985-447-2205
Mailing Address - Fax:985-446-9977
Practice Address - Street 1:1002 TIGER DR
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-6634
Practice Address - Country:US
Practice Address - Phone:985-447-2205
Practice Address - Fax:985-446-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA129314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1511129Medicaid
LA1511129Medicaid