Basic Information
| Provider Information | |||||||||
| NPI: | 1073569067 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EGAN HEALTHCARE OF PLAQUEMINES INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 51266 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705051266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372331307 | ||||||||
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| Practice Location | |||||||||
| Address1: | 880 W COMMERCE RD STE 500 | ||||||||
| Address2: | |||||||||
| City: | HARAHAN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701233330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048354474 | ||||||||
| FaxNumber: | 5048323292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | PROFFIT | ||||||||
| AuthorizedOfficialFirstName: | JOSHUA | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3372331307 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | N | Agencies | Nursing Care | 251E00000X | 909 | LA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 1401951 | 05 | LA | MEDICAID |