1609009844 NPI number — BAYOU HOME CARE OF ACADIANA, LLC

Table of content: (NPI 1609009844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609009844 NPI number — BAYOU HOME CARE OF ACADIANA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYOU HOME CARE OF ACADIANA, 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:
VITALCARING GROUP
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:
1609009844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8150 N CENTRAL EXPY STE 1800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75206-1883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-839-3777
Provider Business Mailing Address Fax Number:
469-983-2083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 DAVID DR
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
MORGAN CITY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70380-1381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-329-2273
Provider Business Practice Location Address Fax Number:
985-384-4280
Provider Enumeration Date:
09/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
ANGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSING MANAGER
Authorized Official Telephone Number:
903-787-7609

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  986 , 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: 1406180 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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