Provider Demographics
NPI:1942352828
Name:MAISON ORLEANS I, LLC
Entity Type:Organization
Organization Name:MAISON ORLEANS I, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:G
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:225-343-9152
Mailing Address - Street 1:343 3RD ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70801-1309
Mailing Address - Country:US
Mailing Address - Phone:225-343-9152
Mailing Address - Fax:225-343-9154
Practice Address - Street 1:2310 MEHLE ST
Practice Address - Street 2:
Practice Address - City:ARABI
Practice Address - State:LA
Practice Address - Zip Code:70032-1444
Practice Address - Country:US
Practice Address - Phone:225-343-9152
Practice Address - Fax:225-343-9154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA196314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA51745Medicaid
LA51745Medicaid