Provider Demographics
NPI:1437228772
Name:WINDFALL REAL ESTATE CORP
Entity Type:Organization
Organization Name:WINDFALL REAL ESTATE CORP
Other - Org Name:JAGNEAUXS THRIFTY WAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGNEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-585-2382
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:PORT BARRE
Mailing Address - State:LA
Mailing Address - Zip Code:70577-0550
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17695 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:PORT BARRE
Practice Address - State:LA
Practice Address - Zip Code:70577-5178
Practice Address - Country:US
Practice Address - Phone:337-585-2382
Practice Address - Fax:337-585-2385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
LAPHY001123IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2029798OtherPK
LA1241229Medicaid