Provider Demographics
NPI:1851936454
Name:LEE DALES HOME CARE AGENCY
Entity Type:Organization
Organization Name:LEE DALES HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARIET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-520-1813
Mailing Address - Street 1:3419 NW EVANGELINE TRWY
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-6241
Mailing Address - Country:US
Mailing Address - Phone:337-520-1813
Mailing Address - Fax:
Practice Address - Street 1:3419 NW EVANGELINE TRWY
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-6241
Practice Address - Country:US
Practice Address - Phone:337-520-1813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care