Organization
NORMAL LIFE OF LAFAYETTE, INC.
Active
Other names
Braewood Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEENA G. OMBRES (ASSOC. GEN. COUNSEL/PRIVACY OFFICER)
(502) 394-2387
Entity
Organization
Contact information
Practice address
773 BRAEWOOD AVE, BATON ROUGE, LA 70815-7202
(225) 778-5194
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
—
1716073
VENDOR #
LA
01
—
872
LICENSE NO.
LA
Enumeration date
01/09/2012
Last updated
01/09/2012
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