Provider Demographics
NPI:1174749899
Name:GERALDINE ENTERPRISES, INC.
Entity type:Organization
Organization Name:GERALDINE ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BONVILLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-868-1016
Mailing Address - Street 1:3200 STEPHANIE ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-3730
Mailing Address - Country:US
Mailing Address - Phone:985-868-1016
Mailing Address - Fax:
Practice Address - Street 1:3200 STEPHANIE ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363-3730
Practice Address - Country:US
Practice Address - Phone:985-868-1016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1135372Medicaid
LA4468970001Medicare NSC