Provider Demographics
NPI:1619000700
Name:LIL LUS BOOMING ENTERPRISE, INC
Entity Type:Organization
Organization Name:LIL LUS BOOMING ENTERPRISE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-682-2440
Mailing Address - Street 1:6201 E SAINT BERNARD HWY STE E
Mailing Address - Street 2:
Mailing Address - City:VIOLET
Mailing Address - State:LA
Mailing Address - Zip Code:70092-3459
Mailing Address - Country:US
Mailing Address - Phone:504-682-2440
Mailing Address - Fax:504-682-6668
Practice Address - Street 1:6201 E SAINT BERNARD HWY STE E
Practice Address - Street 2:
Practice Address - City:VIOLET
Practice Address - State:LA
Practice Address - Zip Code:70092-3459
Practice Address - Country:US
Practice Address - Phone:504-682-2440
Practice Address - Fax:504-682-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA10033251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1124451Medicaid