Organization
HAVENS GATEWAY PERSONAL CARE FACILITY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALFREDA CARTER JACKSON BA (PRESIDENT CEO)
(225) 343-4740
Entity
Organization
Contact information
Practice address
1200 S ACADIAN THRUWAY, 212, BATON ROUGE, LA 70806-6900
(225) 343-4740
(225) 343-4742
Mailing address
1200 S ACADIAN THRUWAY, 212, BATON ROUGE, LA 70806-6900
(225) 343-4740
(225) 343-4742
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
PCA 6770
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1581895
—
LA
Enumeration date
06/09/2008
Last updated
06/09/2008
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