Provider Demographics
NPI:1902005077
Name:VERNON INVESTMENT GROUP, LLC
Entity Type:Organization
Organization Name:VERNON INVESTMENT GROUP, LLC
Other - Org Name:VERNON HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBBOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-239-7227
Mailing Address - Street 1:PO BOX 1550
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71496-1550
Mailing Address - Country:US
Mailing Address - Phone:337-238-0506
Mailing Address - Fax:337-238-1528
Practice Address - Street 1:213 ALEXANDRIA HWY
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-2147
Practice Address - Country:US
Practice Address - Phone:337-238-0506
Practice Address - Fax:337-238-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1088251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
19-7413OtherMEDICARE
19D0716607OtherCLIA
LA07 9806031OtherOCCUPATION LICENSE
LA401OtherDHH