Provider Demographics
NPI:1497003933
Name:BEDSIDE HOMECARE II, LLC
Entity Type:Organization
Organization Name:BEDSIDE HOMECARE II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORLET
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-269-5885
Mailing Address - Street 1:2900 MOSS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-1268
Mailing Address - Country:US
Mailing Address - Phone:337-269-5885
Mailing Address - Fax:337-269-5884
Practice Address - Street 1:2900 MOSS ST
Practice Address - Street 2:SUITE B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-1268
Practice Address - Country:US
Practice Address - Phone:337-269-5885
Practice Address - Fax:337-269-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15320251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1073253Medicaid
LA1073202Medicaid
LA1889652Medicaid