Provider Demographics
NPI:1750417416
Name:VONNIEAB'S RESPITE CARE, INC.
Entity type:Organization
Organization Name:VONNIEAB'S RESPITE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:225-381-8090
Mailing Address - Street 1:731 SAINT LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-6455
Mailing Address - Country:US
Mailing Address - Phone:225-381-8090
Mailing Address - Fax:225-381-8094
Practice Address - Street 1:731 SAINT LOUIS ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-6455
Practice Address - Country:US
Practice Address - Phone:225-381-8090
Practice Address - Fax:225-381-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7922251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1116084Medicaid