1598723769 NPI number — PLAQUEMINE CARING, LLC

Table of content: (NPI 1598723769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598723769 NPI number — PLAQUEMINE CARING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLAQUEMINE CARING, LLC
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:
LEGACY NURSING AND REHABILITATION OF PLAQUEMINE
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:
1598723769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
59215 RIVER WEST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAQUEMINE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70764-6552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-687-0240
Provider Business Mailing Address Fax Number:
225-687-0249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
59215 RIVER WEST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAQUEMINE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70764-6552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-687-0240
Provider Business Practice Location Address Fax Number:
225-687-0249
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUM
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
225-800-4955

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  441 , 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: 1520080 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com