Provider Demographics
NPI:1487651360
Name:FLEUR DE LIS HEALTHCARE, LLC
Entity Type:Organization
Organization Name:FLEUR DE LIS HEALTHCARE, LLC
Other - Org Name:COLFAX REUNION NURSING AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:IMHOFF
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:225-784-8190
Mailing Address - Street 1:366 WEBB SMITH DR
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:LA
Mailing Address - Zip Code:71417-1910
Mailing Address - Country:US
Mailing Address - Phone:318-627-3207
Mailing Address - Fax:318-627-3220
Practice Address - Street 1:366 WEBB SMITH DR
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:LA
Practice Address - Zip Code:71417-1910
Practice Address - Country:US
Practice Address - Phone:318-627-3207
Practice Address - Fax:318-627-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA195430314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA860Medicaid
LA860Medicaid