Provider Demographics
NPI:1437283389
Name:E D & J GROUP HOME
Entity Type:Organization
Organization Name:E D & J GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BYKEN
Authorized Official - Middle Name:GENEVA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-272-0269
Mailing Address - Street 1:PO BOX 657
Mailing Address - Street 2:
Mailing Address - City:VIOLET
Mailing Address - State:LA
Mailing Address - Zip Code:70092
Mailing Address - Country:US
Mailing Address - Phone:504-272-0269
Mailing Address - Fax:504-272-0271
Practice Address - Street 1:5000 ST CLAUDE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117
Practice Address - Country:US
Practice Address - Phone:504-272-0269
Practice Address - Fax:504-272-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
LAPROVIDER#1476871251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1476871Medicaid