# BAYOU HOME CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164162236
- **Authorized official:** CANDI ANTOINETTE WILSON RN (CEO)
- **Authorized official phone:** (337) 459-6142

## Contact information

- **Practice address:** 516 BRUIN CT, STOCKBRIDGE, GA 30281-7791
- **Practice address phone:** (337) 459-6142
- **Mailing address:** 516 BRUIN CT, STOCKBRIDGE, GA 30281-7791
- **Mailing address phone:** (337) 459-6142

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | — | Yes |

## Other

- **Enumeration date:** 03/29/2022
- **Last updated:** 03/29/2022