1912922147 NPI number — AVOYELLES MANOR, INC.

Table of content: (NPI 1912922147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912922147 NPI number — AVOYELLES MANOR, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVOYELLES MANOR, INC.
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:
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:
1912922147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5682 HIGHWAY 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUPONT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-922-3404
Provider Business Mailing Address Fax Number:
318-922-3680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5682 HWY 107 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUPONT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-922-3404
Provider Business Practice Location Address Fax Number:
318-922-3680
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEPITON
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
318-922-3404

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  240 , 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: 1514951 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190031190Z . This is a "PROVIDER NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com