Provider Demographics
NPI:1215995915
Name:COMMUNITY CARE CENTER OF NAPOLEONVILLE LLC
Entity type:Organization
Organization Name:COMMUNITY CARE CENTER OF NAPOLEONVILLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-709-1408
Mailing Address - Street 1:252 HIGHWAY 402
Mailing Address - Street 2:
Mailing Address - City:NAPOLEONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70390-2218
Mailing Address - Country:US
Mailing Address - Phone:985-369-6011
Mailing Address - Fax:985-369-2473
Practice Address - Street 1:252 HIGHWAY 402
Practice Address - Street 2:
Practice Address - City:NAPOLEONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70390-2218
Practice Address - Country:US
Practice Address - Phone:985-369-6011
Practice Address - Fax:985-369-2473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA780314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA31047OtherBLUE CROSS BLUE SHIELD
LA385H00000XOtherRESPITE CARE
LA1521426Medicaid
LA1521426Medicaid