MEDICARE: COMMUNITY CARE CENTER OF ST MARTINVILLE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	783	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31058	OTHER	LA	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093773301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE CENTER OF ST MARTINVILLE LLC

Provider Business Mailing Address
First Line	:	1710 SMEDE HWY
Second Line	:
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-7703
Country	:	US
Telephone Number	:	337-394-6044
Fax Number	:	337-394-7044

Provider Business Practice Location Address
First Line	:	1710 SMEDE HWY
Second Line	:
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582
Country	:	US
Telephone Number	:	337-394-6044
Fax Number	:	337-394-7044

Authorized Official
Title or Position	:	AUTHORIZED REPRESENTATIVE
Name	:	MS. TONI PARKINSON
Credential	:
Telephone Number	:	601-709-1408

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	11/30/2024

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