Healthcare Provider Details

I. General information

NPI: 1649375726
Provider Name (Legal Business Name): ASCENSION CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W CORNERVIEW ST
GONZALES LA
70737-3307
US

IV. Provider business mailing address

1039 E HIGHWAY 30
GONZALES LA
70737-4757
US

V. Phone/Fax

Practice location:
  • Phone: 225-644-6581
  • Fax: 225-644-8430
Mailing address:
  • Phone: 225-644-4853
  • Fax: 225-647-9658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number804
License Number StateLA

VIII. Authorized Official

Name: MR. CLINT PAUL GUILLOT
Title or Position: OWNER/MEMBER
Credential:
Phone: 225-644-4853