Provider Demographics
NPI:1750753893
Name:AFNB HOME CARE LLC
Entity type:Organization
Organization Name:AFNB HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FACKRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-4779
Mailing Address - Street 1:PO BOX 60366
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70596-0366
Mailing Address - Country:US
Mailing Address - Phone:337-233-4778
Mailing Address - Fax:
Practice Address - Street 1:5319 DIDESSE DR STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-6401
Practice Address - Country:US
Practice Address - Phone:225-810-4556
Practice Address - Fax:225-810-4559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203782460253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care