Organization
NORMAL LIFE OF LAFAYETTE, INC.
Active
Other names
Pecos Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEENA G. OMBRES (ASSOC. GEN. COUNSEL/PRIVACY OFFICER)
(502) 394-2100
Entity
Organization
Contact information
Practice address
12804 PECOS AVE, GREENWELL SPRINGS, LA 70739-3047
(225) 757-6192
Mailing address
9901 LINN STATION RD, LOUISVILLE, KY 40223-3808
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1717045
VENDOR #
LA
01
—
886
OLD LICENSE NO.
LA
Enumeration date
01/18/2012
Last updated
01/18/2012
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