Healthcare Provider Details

I. General information

NPI: 1942258876
Provider Name (Legal Business Name): COMMUNITY CARE CENTER OF COVINGTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/30/2024
Certification Date: 11/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 OCHSNER BLVD
COVINGTON LA
70433-8172
US

IV. Provider business mailing address

1330 OCHSNER BLVD
COVINGTON LA
70433-8172
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-6900
  • Fax: 985-892-7857
Mailing address:
  • Phone: 985-892-6900
  • Fax: 985-892-7857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number776
License Number StateLA

VIII. Authorized Official

Name: MS. TONI PARKINSON
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 601-709-1408