Provider Demographics
NPI:1467179341
Name:STANDARD BATH LLC
Entity Type:Organization
Organization Name:STANDARD BATH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HEFLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:504-442-5245
Mailing Address - Street 1:804 COLONY PL
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-2414
Mailing Address - Country:US
Mailing Address - Phone:504-442-5245
Mailing Address - Fax:
Practice Address - Street 1:804 COLONY PL
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-2414
Practice Address - Country:US
Practice Address - Phone:504-442-5245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1942833314Medicaid