Provider Demographics
NPI:1952049199
Name:MARY LEE'S HOUSE OF LOVE ADULT DAY HEALTH CARE
Entity Type:Organization
Organization Name:MARY LEE'S HOUSE OF LOVE ADULT DAY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VAUGHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-662-3081
Mailing Address - Street 1:PO BOX 1022
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:LA
Mailing Address - Zip Code:70584-1022
Mailing Address - Country:US
Mailing Address - Phone:337-662-3081
Mailing Address - Fax:
Practice Address - Street 1:805 NAPOLEON AVE SUITE B
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:LA
Practice Address - Zip Code:70584
Practice Address - Country:US
Practice Address - Phone:337-662-3081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care