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LOUISE S DAVIS RESIDENTIAL FACILITIES LLC NPI 1386760098


NPI Information

NPI: 1386760098
Provider Name: LOUISE S DAVIS RESIDENTIAL FACILITIES, LLC

Doing Business As: ANDOVER GROUP HOME

Classification: Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320600000X
Entity Type: Organization
Address:
22336 SUTTER LN
ZACHARY, LA
ZIP 70791
Phone: (225) 654-3897
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LOUISE S DAVIS RESIDENTIAL FACILITIES, LLC is a residential treatment facility, intellectual and/or developmental disabilities in Zachary, LA. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. LOUISE S DAVIS RESIDENTIAL FACILITIES, LLC NPI is 1386760098. The provider is registered as an organization entity type.
The provider Is Doing Business As Andover Group Home.

The provider's business location address is:

22336 SUTTER LN
ZACHARY, LA
ZIP 70791-003
Phone: (225) 654-3897
Fax: (225) 658-8396

The provider's authorized official is Kendall A Broussard .
The authorized official title is Managing Member and has the following contact phone number (337) 439-6600.

The enumeration date for this NPI number is 3/22/2007 and was last updated on 10/8/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1320600000XResidential Treatment Facility, Intellectual and/or Developmental Disabilities966LOUISIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11711071MEDICAIDLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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