Provider Demographics
NPI:1649585365
Name:ADULT DAY HEALTH CARE OF LIVINGSTON PARISH, LLC
Entity Type:Organization
Organization Name:ADULT DAY HEALTH CARE OF LIVINGSTON PARISH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:225-665-5893
Mailing Address - Street 1:2011 FLORIDA AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4914
Mailing Address - Country:US
Mailing Address - Phone:225-665-5893
Mailing Address - Fax:225-304-6333
Practice Address - Street 1:2011 FLORIDA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4914
Practice Address - Country:US
Practice Address - Phone:225-665-5893
Practice Address - Fax:225-304-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care