Provider Demographics
NPI:1669533261
Name:NORTHEAST LA HOME CARE
Entity type:Organization
Organization Name:NORTHEAST LA HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-649-0653
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:CLARKS
Mailing Address - State:LA
Mailing Address - Zip Code:71415-0096
Mailing Address - Country:US
Mailing Address - Phone:318-649-0653
Mailing Address - Fax:
Practice Address - Street 1:8636 HWY 165 S
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:LA
Practice Address - Zip Code:71418
Practice Address - Country:US
Practice Address - Phone:318-649-0653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10414311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1469700Medicaid