1972835130 NPI number — LAFAYETTE HEALTH VENTURES, INC

Table of content: (NPI 1972835130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972835130 NPI number — LAFAYETTE HEALTH VENTURES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAFAYETTE HEALTH VENTURES, 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:
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:
1972835130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 53092
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70505-3092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-289-8933
Provider Business Mailing Address Fax Number:
337-289-8982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 COOLIDGE BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-289-8044
Provider Business Practice Location Address Fax Number:
337-289-8401
Provider Enumeration Date:
02/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DOOLEY
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
337-571-1394

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2115103 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CG2600 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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