Organization
ANGEL MANOR, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN SAMUEL FORD JR. (ADMINISTRATOR)
(337) 232-7761
Entity
Organization
Contact information
Practice address
708 S WASHINGTON ST, LAFAYETTE, LA 70501-6810
(337) 232-7761
(337) 232-7762
Mailing address
708 S WASHINGTON ST, LAFAYETTE, LA 70501-6810
(337) 232-7761
(337) 232-7762
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
251C00000X
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134490
—
LA
Enumeration date
02/22/2007
Last updated
08/22/2020
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