Basic Information
| Provider Information | |||||||||
| NPI: | 1427031582 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEAUREGARD MEMORIAL HOME HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 S PINE ST | ||||||||
| Address2: | |||||||||
| City: | DERIDDER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706344942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374627189 | ||||||||
| FaxNumber: | 3374627455 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 S PINE ST | ||||||||
| Address2: | |||||||||
| City: | DERIDDER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706344942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374627189 | ||||||||
| FaxNumber: | 3374627455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 08/03/2007 | ||||||||
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| AuthorizedOfficialLastName: | VERRETT | ||||||||
| AuthorizedOfficialFirstName: | ROXANA | ||||||||
| AuthorizedOfficialMiddleName: | EVETTE | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3374627189 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 251E00000X | LA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 1401838 | 05 | LA | MEDICAID |