1487090254 NPI number — FC2013, L.L.C.

Table of content: (NPI 1487090254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487090254 NPI number — FC2013, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FC2013, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FERNCREST MANOR LIVING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487090254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 800
Provider Second Line Business Mailing Address:
11429 FERDINAND
Provider Business Mailing Address City Name:
SAINT FRANCISVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70775-0800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-927-4290
Provider Business Mailing Address Fax Number:
225-927-5385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14500 HAYNE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70128-1751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-927-4290
Provider Business Practice Location Address Fax Number:
225-927-5385
Provider Enumeration Date:
05/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
225-927-4290

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1520292 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com