La Bodega Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

922 Issued in LA

Legal business name

LA BODEGA INC

Practice address

1579 Highway 51
Ponchatoula, LA 70454-6374

Phone

(985) 635-6900

Fax

(985) 635-6936

NPI assigned

Oct 26, 2006

Organization subpart

No

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

Authorized official

Name

Milton R Mize

Title

Owner/President

Phone

(985) 635-6900

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• AmeraCare Home Health Doing business as

Locations

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619481600000",
    "number": "1891870929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 W 21ST AVE",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704333153",
            "telephone_number": "985-635-6900",
            "fax_number": "985-635-6936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1579 HIGHWAY 51",
            "city": "PONCHATOULA",
            "state": "LA",
            "postal_code": "704546374",
            "telephone_number": "985-635-6900",
            "fax_number": "985-635-6936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA BODEGA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A",
        "authorized_official_last_name": "MIZE",
        "authorized_official_first_name": "MILTON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "985-635-6900"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "LA",
            "license": "922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1401439",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AmeraCare Home Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AmeraCare Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Ponchatoula, LA
• Home Health Agency in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2021; 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.