Provider Demographics
NPI:1447425376
Name:LEE ANNS ASSISTED LIVING
Entity Type:Organization
Organization Name:LEE ANNS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAGGENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-687-8137
Mailing Address - Street 1:57835 HAASE ST
Mailing Address - Street 2:P O BOX 1422
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-3329
Mailing Address - Country:US
Mailing Address - Phone:225-687-8137
Mailing Address - Fax:225-687-6311
Practice Address - Street 1:57835 HAASE ST
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-3329
Practice Address - Country:US
Practice Address - Phone:225-687-8137
Practice Address - Fax:225-687-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA140413747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1024503Medicaid
LA1008702Medicaid
LA1031119Medicaid