Organization
BAYOU HOME BUREAU
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUANETTA MARTIN LPN (OWNER)
(318) 556-0043
Entity
Organization
Contact information
Practice address
8057 WILLIARD RD, BASTROP, LA 71220-8939
(318) 556-0043
(318) 556-3633
Mailing address
8057 WILLIARD RD, PO BOX 561, BASTROP, LA 71220-8939
(318) 556-0043
(318) 556-3633
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
PCA8246
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1171506
—
LA
05
—
1564761
—
LA
Enumeration date
01/07/2008
Last updated
01/07/2008
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