MEDICARE: MORGAN CITY OPCO, L.L.C.

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

General Provider Information

NPI Number	:	1861038051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORGAN CITY OPCO, L.L.C.

Provider Business Mailing Address
First Line	:	740 JUSTA ST
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1513
Country	:	US
Telephone Number	:	985-384-1723
Fax Number	:	985-384-4942

Provider Business Practice Location Address
First Line	:	740 JUSTA ST
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1513
Country	:	US
Telephone Number	:	985-384-1723
Fax Number	:	985-384-4942

Authorized Official
Title or Position	:	MANAGER
Name	:	V. DEVIN GUM
Credential	:
Telephone Number	:	225-800-4954

Provider Enumeration Date	:	11/22/2019
Last Update Date	:	11/22/2019

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