Provider Demographics
NPI:1306948682
Name:SOUTHWEST LOUISIANA VETERANS HOME
Entity type:Organization
Organization Name:SOUTHWEST LOUISIANA VETERANS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LONG-TERM CARE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DAVE
Authorized Official - Last Name:DUHON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, NFA
Authorized Official - Phone:337-824-2829
Mailing Address - Street 1:1610 EVANGELINE RD
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-3922
Mailing Address - Country:US
Mailing Address - Phone:337-824-2829
Mailing Address - Fax:337-824-2581
Practice Address - Street 1:1610 EVANGELINE RD
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3922
Practice Address - Country:US
Practice Address - Phone:337-824-2829
Practice Address - Fax:337-824-2581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
LA03-134314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA195608Medicare ID - Type Unspecified