Provider Demographics
NPI:1144703893
Name:BAYOU ANGELS SENIOR CARE LLC
Entity type:Organization
Organization Name:BAYOU ANGELS SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-798-6847
Mailing Address - Street 1:19523 OTTER TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4551
Mailing Address - Country:US
Mailing Address - Phone:832-798-6847
Mailing Address - Fax:
Practice Address - Street 1:19523 OTTER TRAIL CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-4551
Practice Address - Country:US
Practice Address - Phone:832-798-6847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care