Organization
2707 LAF SNF LLC
Active
Other names
MAISON DE LAFAYETTE
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES MOODY III (AUTHORIZED AGENT)
(225) 939-6766
Entity
Organization
Contact information
Practice address
2707 KALISTE SALOOM RD, LAFAYETTE, LA 70508-7139
(337) 981-2258
Mailing address
2707 KALISTE SALOOM RD, LAFAYETTE, LA 70508-7139
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/16/2022
Last updated
02/18/2022
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