ANDOVER GROUP HOME – NPI #1386760098
Residential Treatment Facility, Intellectual and/or Developmental Disabilities

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

ANDOVER GROUP HOME is a residential treatment facility located in ZACHARY, LA. NPPES has assigned the NPI number 1386760098 to ANDOVER GROUP HOME on March 22, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “ANDOVER GROUP HOME” is a dba name, the actual legal business name for this organization is LOUISE S DAVIS RESIDENTIAL FACILITIES, LLC. The primary taxonomy selected by this provider is 320600000X from the Health Care Provider Taxonomy code set, which is classified as Residential Treatment Facility, Intellectual and/or Developmental Disabilities.

The NPI profile was previously updated about 18 years ago on Oct 08, 2008. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for ANDOVER GROUP HOME below.

NPI Profile for
LOUISE S DAVIS RESIDENTIAL FACILITIES, LLC

NPI Number
1386760098
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
LOUISE S DAVIS RESIDENTIAL FACILITIES, LLC
Doing Business As (dba): ANDOVER GROUP HOME
Primary location
22336 SUTTER LN
ZACHARY, LA 70791-6003
Phone: (225) 654-3897 Fax: (225) 658-8396
Mailing address
1 LAKESHORE DR
SUITE 1900
LAKE CHARLES, LA 70629-0100
Phone: (337) 439-6600 Fax: (337) 439-6647
Organization Subpart
No
Authorized Official
KENDALL BROUSSARD
MANAGING MEMBER
Phone: (337) 439-6600
Updated
Identifiers

Identifiers for ANDOVER GROUP HOME

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDLA1711071
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
320600000X
- Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Primary)
LA 966

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.