1073553749 NPI number — APEX HOME HEALTH, L.L.C.

Table of content: (NPI 1073553749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073553749 NPI number — APEX HOME HEALTH, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APEX HOME HEALTH, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ULTRA HOME HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073553749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1402 S MAGNOLIA ST STE I&J
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMOND
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70403-5020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-662-0552
Provider Business Mailing Address Fax Number:
985-467-5704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68425 HIGHWAY 59
Provider Second Line Business Practice Location Address:
SUITE #7
Provider Business Practice Location Address City Name:
MANDEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70471-7753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-288-0034
Provider Business Practice Location Address Fax Number:
985-288-5629
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITMAN
Authorized Official First Name:
MARCEL
Authorized Official Middle Name:
EMILE
Authorized Official Title or Position:
ADMIN
Authorized Official Telephone Number:
985-710-9955

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  961 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SB670 . This is a "BCBS LA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1403237 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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