Pedialife of la, L.L.C.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PEDIALIFE OF LA, L.L.C.

Practice address

2427 Riverside Dr.
Port Allen, LA 70767-6009

Phone

(817) 296-5938

Fax

(817) 563-5435

NPI assigned

Feb 17, 2020

Last updated

Feb 17, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Develle Marie Coleman, MSN, RN

Title

President

Phone

(817) 296-5938

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581897600000",
    "number": "1568095719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2427 RIVERSIDE DR.",
            "city": "PORT ALLEN",
            "state": "LA",
            "postal_code": "707676009",
            "telephone_number": "817-296-5938",
            "fax_number": "817-563-5435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2427 RIVERSIDE DR.",
            "city": "PORT ALLEN",
            "state": "LA",
            "postal_code": "707676009",
            "telephone_number": "817-296-5938",
            "fax_number": "817-563-5435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIALIFE OF LA, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-17",
        "last_updated": "2020-02-17",
        "certification_date": "2020-02-17",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "DEVELLE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-296-5938",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSN, RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Dane Owens, DC
• Philip G Padgett, MD
• Jocques Parker
• Rebecca Parker, M.A., CCC-SLP
• Eleanor Allen Parrish, APRN,PMHNP-BC,FNP-C
• Kirkland Pelichet
• Philip G. Padgett, Ampc (WBR Family and Occupational Medicine Clinic)
• Port Allen Care Center, LLC (Legacy Nursing and Rehabilitation of Port Allen)
• Port Allen Pharmacy
• Port Allen Supermarket Inc

• Home Health Agency in Port Allen, LA
• Providers in Port Allen, LA by specialty
• Home Health Agency in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.