Provider Demographics
NPI:1427233550
Name:LAKE AREA HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:LAKE AREA HOME HEALTH AGENCY, INC.
Other - Org Name:HOME HEALTH CARE 2000 - OAKDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:337-562-1140
Mailing Address - Street 1:1901 OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8915
Mailing Address - Country:US
Mailing Address - Phone:337-562-1140
Mailing Address - Fax:337-562-1142
Practice Address - Street 1:144 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-2616
Practice Address - Country:US
Practice Address - Phone:318-335-0973
Practice Address - Fax:318-335-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1194251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1406384Medicaid
LA=========OtherFEDERAL TAX ID NO. (TIN)
LA=========OtherFEDERAL TAX ID NO. (TIN)