Organization
ACTIVITIES OF DAILY LIVING
Active
Other names
Activities of Daily Living
Organization subpart
No
Provider details
NPI number
Authorized official
STELLA WILTZ (OWNER)
(337) 332-1810
Entity
Organization
Contact information
Practice address
400 RICHARD ST, BREAUX BRIDGE, LA 70517-6039
(337) 332-1810
Mailing address
400 RICHARD ST, BREAUX BRIDGE, LA 70517-6039
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172999
—
LA
Enumeration date
04/30/2020
Last updated
04/30/2020
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