Provider Demographics
NPI:1740844620
Name:ALLEGIANCE HOME HEALTH OF SOUTHWEST LOUISIANA, LLC
Entity type:Organization
Organization Name:ALLEGIANCE HOME HEALTH OF SOUTHWEST LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-462-3747
Mailing Address - Street 1:108 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4024
Mailing Address - Country:US
Mailing Address - Phone:337-462-3747
Mailing Address - Fax:337-462-3790
Practice Address - Street 1:108 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4024
Practice Address - Country:US
Practice Address - Phone:337-462-3747
Practice Address - Fax:337-462-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA31245OtherBCBS
LA2623141Medicaid