Provider Demographics
NPI:1396118006
Name:PB HEALTHCARE OPERATIONS LLC
Entity type:Organization
Organization Name:PB HEALTHCARE OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-719-2517
Mailing Address - Street 1:10153 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-4222
Mailing Address - Country:US
Mailing Address - Phone:225-272-1401
Mailing Address - Fax:225-272-0685
Practice Address - Street 1:14333 OLD HAMMOND HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-1146
Practice Address - Country:US
Practice Address - Phone:225-272-1401
Practice Address - Fax:225-272-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA915314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility