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Organization

LA BODEGA INC

Active
Other names
AmeraCare Home Health
Organization subpart
No

Provider details

NPI number
Authorized official
MILTON R MIZE (OWNER/PRESIDENT)
(985) 635-6900
Entity
Organization

Contact information

Practice address
1579 HIGHWAY 51, PONCHATOULA, LA 70454-6374
(985) 635-6900
(985) 635-6936
Mailing address
327 W 21ST AVE, COVINGTON, LA 70433-3153
(985) 635-6900
(985) 635-6936

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
922
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1401439
LA
Enumeration date
10/26/2006
Last updated
04/27/2021
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