Provider Demographics
NPI:1508099375
Name:BAYOU INDUSTRIAL MAINTENANCE SERVICES, INC.
Entity Type:Organization
Organization Name:BAYOU INDUSTRIAL MAINTENANCE SERVICES, INC.
Other - Org Name:BIMS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-384-2003
Mailing Address - Street 1:2675 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:LA
Mailing Address - Zip Code:70342-2835
Mailing Address - Country:US
Mailing Address - Phone:985-384-2009
Mailing Address - Fax:
Practice Address - Street 1:2675 4TH ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:LA
Practice Address - Zip Code:70342-2835
Practice Address - Country:US
Practice Address - Phone:985-384-2009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAADC2513251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1960870Medicaid