Provider Demographics
NPI:1861678021
Name:HOME HEALTH PROFESSIONAL
Entity Type:Organization
Organization Name:HOME HEALTH PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-667-2792
Mailing Address - Street 1:722 S RANGE AVE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4401
Mailing Address - Country:US
Mailing Address - Phone:225-667-7279
Mailing Address - Fax:
Practice Address - Street 1:2550 FLORIDA BLVD SW
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4951
Practice Address - Country:US
Practice Address - Phone:225-667-2792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA625251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1405337Medicaid
LA197589Medicare Oscar/Certification