Organization
ANGEL MANOR- BREAUX BRIDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN SAMUEL FORD JR. (ADMINISTRATOR)
(337) 332-3421
Entity
Organization
Contact information
Practice address
329 W BRIDGE ST, BREAUX BRIDGE, LA 70517-5040
(337) 332-3421
(337) 332-3461
Mailing address
329 W BRIDGE ST, BREAUX BRIDGE, LA 70517-5040
(337) 332-3421
(337) 332-3461
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
251C00000X
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1318744
—
LA
Enumeration date
03/06/2007
Last updated
08/22/2020
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