1255540662 NPI number — LHCG-XII, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255540662 NPI number — LHCG-XII, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LHCG-XII, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1255540662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 W PINHOOK RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70503-2131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-233-1307
Provider Business Mailing Address Fax Number:
337-233-5764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3879 HIGHWAY 190
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUNICE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70535-7900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-546-0024
Provider Business Practice Location Address Fax Number:
337-546-0703
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
INDEST
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT AND COO
Authorized Official Telephone Number:
337-233-1307

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  607-B , 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: 1700665 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com