Provider Demographics
NPI:1043573942
Name:YOUNGSVILLE FAMILY HEALTHCARE
Entity type:Organization
Organization Name:YOUNGSVILLE FAMILY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:337-857-6657
Mailing Address - Street 1:3215 E MILTON AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5546
Mailing Address - Country:US
Mailing Address - Phone:337-857-6657
Mailing Address - Fax:337-857-6658
Practice Address - Street 1:3215 E MILTON AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5546
Practice Address - Country:US
Practice Address - Phone:337-857-6657
Practice Address - Fax:337-857-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-17
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AP03677261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1128147Medicaid