Organization
A NEW MEDICAL LEVEL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CRYSTAL SMITH-PROVOST (ADMINISTRATOR)
(337) 347-4718
Entity
Organization
Contact information
Practice address
1512 AMBASSADOR CAFFERY PKWY STE 5, LAFAYETTE, LA 70506-1826
(337) 254-6890
(337) 332-6758
Mailing address
208 DURHAM DR, LAFAYETTE, LA 70508-6947
(337) 254-6890
(337) 332-6758
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
11/04/2021
Last updated
11/04/2021
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