Provider Demographics
NPI:1730163247
Name:EVANGELINE HOME HEALTH AGENCY INC
Entity type:Organization
Organization Name:EVANGELINE HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEKKI
Authorized Official - Middle Name:ARDOIN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:337-363-5617
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-0556
Mailing Address - Country:US
Mailing Address - Phone:337-363-5617
Mailing Address - Fax:337-363-5079
Practice Address - Street 1:1424 FUSELIER AVE
Practice Address - Street 2:
Practice Address - City:BASILE
Practice Address - State:LA
Practice Address - Zip Code:70515-5583
Practice Address - Country:US
Practice Address - Phone:337-432-5986
Practice Address - Fax:337-432-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA44251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1400386Medicaid
LA197038Medicare ID - Type UnspecifiedPROVIDER NUMBER