Provider Demographics
NPI:1518061522
Name:HOMER MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HOMER MEMORIAL HOSPITAL
Other - Org Name:CLAIBORNE MEMORIAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CNO
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:318-927-2024
Mailing Address - Street 1:620 NORTH COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-3202
Mailing Address - Country:US
Mailing Address - Phone:318-927-9119
Mailing Address - Fax:318-927-6057
Practice Address - Street 1:620 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-3202
Practice Address - Country:US
Practice Address - Phone:318-927-9119
Practice Address - Fax:318-927-6057
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOMER MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-11
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1402541Medicaid
LA1402541Medicaid