Provider Demographics
NPI:1518003508
Name:BAYOU HEALTH ELDERLY & DISABLED CARE, INC.
Entity Type:Organization
Organization Name:BAYOU HEALTH ELDERLY & DISABLED CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-384-8621
Mailing Address - Street 1:544 FREDERICK DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6033
Mailing Address - Country:US
Mailing Address - Phone:985-384-8621
Mailing Address - Fax:985-384-8622
Practice Address - Street 1:1201 BRASHEAR AVE STE 426
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1358
Practice Address - Country:US
Practice Address - Phone:985-384-8621
Practice Address - Fax:985-384-8622
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYOU HEALTH ELDERLY & DISABLED CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-29
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106823747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1775665Medicaid