Provider Demographics
NPI:1912152018
Name:ABUNDANT LIFE HOMES OF LA. INC
Entity Type:Organization
Organization Name:ABUNDANT LIFE HOMES OF LA. INC
Other - Org Name:ABUNDANCE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:NOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-275-5303
Mailing Address - Street 1:942 MCLEMORE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-1802
Mailing Address - Country:US
Mailing Address - Phone:225-275-5303
Mailing Address - Fax:255-274-1028
Practice Address - Street 1:942 MCLEMORE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-1802
Practice Address - Country:US
Practice Address - Phone:225-275-5303
Practice Address - Fax:255-274-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA629315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1718904Medicaid