NPIMap

Organization Active NPI

Angel Manor- Breaux Bridge

  • Adult Day Care Clinic/Center
  • Breaux Bridge, LA
National Provider Identifier
1942330642
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Day Care Clinic/CenterTaxonomy code 261QA0600X
License
251C00000X Issued in LA
Legal business name
ANGEL MANOR- BREAUX BRIDGE
Practice address
329 W Bridge St
Breaux Bridge, LA 70517-5040
Phone
(337) 332-3421
Fax
(337) 332-3461
NPI assigned
Mar 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. John Samuel Ford Jr.
Title
Administrator
Phone
(337) 332-3421

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X 251C00000X LA Primary

Addresses

Primary practice location

329 W Bridge St
Breaux Bridge, LA 70517-5040

Mailing address

329 W Bridge St
Breaux Bridge, LA 70517-5040
Phone (337) 332-3421

Other identifiers 1

IdentifierTypeStateIssuer
1318744MedicaidLA

National Provider Directory

National Provider Directory
Tax ID family
Angel Manor LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942330642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 W BRIDGE ST",
            "city": "BREAUX BRIDGE",
            "state": "LA",
            "postal_code": "705175040",
            "telephone_number": "337-332-3421",
            "fax_number": "337-332-3461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "329 W BRIDGE ST",
            "city": "BREAUX BRIDGE",
            "state": "LA",
            "postal_code": "705175040",
            "telephone_number": "337-332-3421",
            "fax_number": "337-332-3461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL MANOR- BREAUX BRIDGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "SAMUEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "337-332-3421",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "LA",
            "license": "251C00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1318744",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Breaux Bridge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.