Provider Demographics
NPI:1609860360
Name:OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL
Other - Org Name:ASSUMPTION COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARBONEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-369-4209
Mailing Address - Street 1:135 HIGHWAY 402
Mailing Address - Street 2:
Mailing Address - City:NAPOLEONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70390-2217
Mailing Address - Country:US
Mailing Address - Phone:985-369-4209
Mailing Address - Fax:888-765-2110
Practice Address - Street 1:135 HIGHWAY 402
Practice Address - Street 2:
Practice Address - City:NAPOLEONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70390-2217
Practice Address - Country:US
Practice Address - Phone:985-369-4209
Practice Address - Fax:888-765-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA451282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19-1303Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER