Organization
PEDIALIFE OF LA, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEVELLE MARIE COLEMAN MSN, RN (PRESIDENT)
(817) 296-5938
Entity
Organization
Contact information
Practice address
2427 RIVERSIDE DR., PORT ALLEN, LA 70767-6009
(817) 296-5938
(817) 563-5435
Mailing address
2427 RIVERSIDE DR., PORT ALLEN, LA 70767-6009
(817) 296-5938
(817) 563-5435
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
02/17/2020
Last updated
02/17/2020
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