Provider Demographics
NPI:1134851405
Name:HANSBERRY ADULT DAY HEALTH CARE OF LAFAYETTE, LLC
Entity type:Organization
Organization Name:HANSBERRY ADULT DAY HEALTH CARE OF LAFAYETTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HANSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:337-344-9706
Mailing Address - Street 1:2121 DULLES DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-2652
Mailing Address - Country:US
Mailing Address - Phone:337-484-3221
Mailing Address - Fax:337-484-3227
Practice Address - Street 1:2121 DULLES DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-2652
Practice Address - Country:US
Practice Address - Phone:337-484-3221
Practice Address - Fax:337-484-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1548465867Medicaid