Provider Demographics
NPI:1730237397
Name:MARIE'S FAMILY HEALTHCARE & SITTER SERVICE INC
Entity type:Organization
Organization Name:MARIE'S FAMILY HEALTHCARE & SITTER SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MATILDA
Authorized Official - Middle Name:WATSON
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-574-9009
Mailing Address - Street 1:PO BOX 1404
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71284-1404
Mailing Address - Country:US
Mailing Address - Phone:318-574-9009
Mailing Address - Fax:318-574-9926
Practice Address - Street 1:402 E CRAIG ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-3718
Practice Address - Country:US
Practice Address - Phone:318-574-9009
Practice Address - Fax:318-574-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0006420253Z00000X
LA140563747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1151360Medicaid
LA1124753Medicaid
LA1127159Medicaid
LA1173169Medicaid
LA1477770Medicaid