# CDF HEALTHCARE OF LA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southfork Group Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205051711
- **Authorized official:** MR. JOE DEBOLT (ADMINISTRATOR)
- **Authorized official phone:** (318) 878-5106

## Contact information

- **Practice address:** 149 AFTON RD, TALLULAH, LA 71282-7455
- **Practice address phone:** (318) 574-0704
- **Mailing address:** PO BOX 607, DELHI, LA 71232-0607
- **Mailing address phone:** (318) 878-5106
- **Mailing address fax:** (318) 878-8671

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | 978 | LA | Yes |

## Other

- **Enumeration date:** 04/17/2007
- **Last updated:** 06/09/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1719668 | — | LA |