1356508667 NPI number — VILLA FELICIANA MEDICAL COMPLEX

Table of content: (NPI 1356508667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356508667 NPI number — VILLA FELICIANA MEDICAL COMPLEX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLA FELICIANA MEDICAL COMPLEX
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:
Provider Other Organization Name Type Code:
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:
1356508667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 438
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70748-0438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-634-4017
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5002 HWY 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70748-0438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-634-4017
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
O REAR
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
LONG TERM CARE ADMIN
Authorized Official Telephone Number:
225-634-4017

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  233 , 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: 195150 . This is a "MEDICARE SKILLED - ECF" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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