Provider Demographics
NPI:1912214180
Name:THE COMFORTS OF HOME ADULT DAY HEALTH CARE, LLC
Entity Type:Organization
Organization Name:THE COMFORTS OF HOME ADULT DAY HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHONITRA
Authorized Official - Middle Name:ADONICA
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:504-367-0889
Mailing Address - Street 1:2701 MANHATTAN BLVD STE 14
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-6149
Mailing Address - Country:US
Mailing Address - Phone:504-367-0889
Mailing Address - Fax:504-367-0152
Practice Address - Street 1:2701 MANHATTAN BLVD STE 14
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-6149
Practice Address - Country:US
Practice Address - Phone:504-367-0889
Practice Address - Fax:504-367-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5059311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAADHC 5059OtherSTATE OF LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS LICENSE