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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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