Provider Demographics
NPI:1487090254
Name:FC2013, L.L.C.
Entity type:Organization
Organization Name:FC2013, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-927-4290
Mailing Address - Street 1:PO BOX 800
Mailing Address - Street 2:11429 FERDINAND
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-0800
Mailing Address - Country:US
Mailing Address - Phone:225-927-4290
Mailing Address - Fax:225-927-5385
Practice Address - Street 1:14500 HAYNE BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128-1751
Practice Address - Country:US
Practice Address - Phone:225-927-4290
Practice Address - Fax:225-927-5385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1520292Medicaid
195214Medicare PIN