Provider Demographics
NPI:1508898008
Name:STAT HOME HEALTH OF NORTHWEST LOUISIANA, LLC
Entity Type:Organization
Organization Name:STAT HOME HEALTH OF NORTHWEST LOUISIANA, LLC
Other - Org Name:STAT HOME HEALTH OF NORTHWEST LOUISIANA, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-368-3181
Mailing Address - Street 1:10615 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-7230
Mailing Address - Country:US
Mailing Address - Phone:225-368-3181
Mailing Address - Fax:225-757-1104
Practice Address - Street 1:364 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:LA
Practice Address - Zip Code:71073-2985
Practice Address - Country:US
Practice Address - Phone:318-371-3673
Practice Address - Fax:318-371-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA464251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1404861Medicaid
LA1404861Medicaid