Healthcare Provider Details

I. General information

NPI: 1518236884
Provider Name (Legal Business Name): BAYOU VISTA NURSING AND REHAB CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 EVERGREEN ST
BUNKIE LA
71322-1307
US

IV. Provider business mailing address

PO BOX 270
BUNKIE LA
71322-0270
US

V. Phone/Fax

Practice location:
  • Phone: 318-346-2080
  • Fax: 318-346-7879
Mailing address:
  • Phone: 318-346-2080
  • Fax: 318-346-7879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: PHILIP BONNETTE PEPITON
Title or Position: MANAGER/MEMBER
Credential:
Phone: 318-922-3404