Provider Demographics
NPI:1558658005
Name:CPLACE COLONIAL RC, LLC
Entity type:Organization
Organization Name:CPLACE COLONIAL RC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEBBELN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-723-3021
Mailing Address - Street 1:14686 OLD HAMMOND HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-1235
Mailing Address - Country:US
Mailing Address - Phone:225-272-9339
Mailing Address - Fax:
Practice Address - Street 1:14686 OLD HAMMOND HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-1235
Practice Address - Country:US
Practice Address - Phone:225-272-9339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
195512Medicare Oscar/Certification