Healthcare Provider Details

I. General information

NPI: 1518964725
Provider Name (Legal Business Name): MEADOWCREST LIVING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 COMMERCE ST
GRETNA LA
70056-7316
US

IV. Provider business mailing address

535 COMMERCE ST
GRETNA LA
70056-7316
US

V. Phone/Fax

Practice location:
  • Phone: 504-393-9595
  • Fax:
Mailing address:
  • Phone: 504-393-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number752
License Number StateLA

VIII. Authorized Official

Name: MR. STEPHEN W YANCOVICH
Title or Position: ADMINISTRATOR
Credential: NFA
Phone: 504-393-9595