Provider Demographics
NPI:1336111442
Name:FELICIANA HOME HEALTH INC
Entity Type:Organization
Organization Name:FELICIANA HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-683-3060
Mailing Address - Street 1:PO BOX 8010
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722
Mailing Address - Country:US
Mailing Address - Phone:225-683-3060
Mailing Address - Fax:225-683-5675
Practice Address - Street 1:9735 GRACE LANE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722
Practice Address - Country:US
Practice Address - Phone:225-683-3060
Practice Address - Fax:225-683-5675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA119251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1400963Medicaid
LA18334OtherCLIA
LA197099Medicare ID - Type Unspecified