Provider Demographics
NPI:1386610848
Name:SOUTHEAST LOUISIANA HOME HEALTH, LLC
Entity type:Organization
Organization Name:SOUTHEAST LOUISIANA HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-892-8008
Mailing Address - Street 1:832 E. BOSTON ST.
Mailing Address - Street 2:SUITE 10
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2940
Mailing Address - Country:US
Mailing Address - Phone:985-892-8008
Mailing Address - Fax:985-893-8752
Practice Address - Street 1:832 E. BOSTON ST.
Practice Address - Street 2:SUITE 10
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2940
Practice Address - Country:US
Practice Address - Phone:985-892-8008
Practice Address - Fax:985-893-8752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1400238Medicaid
LA1400238Medicaid