Provider Demographics
NPI:1982820494
Name:CDF HEALTHCARE OF LA, LLC
Entity Type:Organization
Organization Name:CDF HEALTHCARE OF LA, LLC
Other - Org Name:DARROW STREET COMMUNITY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-878-5106
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-0607
Mailing Address - Country:US
Mailing Address - Phone:318-878-5106
Mailing Address - Fax:318-878-9786
Practice Address - Street 1:618 E DARROW ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-3516
Practice Address - Country:US
Practice Address - Phone:318-574-3886
Practice Address - Fax:318-878-9786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2361315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1719315Medicaid