NPI Lookup
NPI Lookup from the NPI Registry — National Provider Identifier Database

Contact Information

ANDOVER GROUP HOME
LBN LOUISE S DAVIS RESIDENTIAL FACILITIES, LLC
22336 SUTTER LN
ZACHARY, LA70791-6003
 Phone: 225-654-3897
 Fax: 225-658-8396
 Website:
Indicates primary specialty

NPI Profile & details for ANDOVER GROUP HOME

NPI Number 1386760098
LBN Legal business name LOUISE S DAVIS RESIDENTIAL FACILITIES, LLC
DBA Doing business as ANDOVER GROUP HOME
Authorized official KENDALL BROUSSARD - (MANAGING MEMBER)
Entity Organization
Organization subpart 1 No
Enumeration date 03/22/2007
Last updated 10/08/2008 - About 8 years ago
Identifiers
LA License # 966
LA Medicaid 1711071
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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