Healthcare Provider Details

I. General information

NPI: 1881206100
Provider Name (Legal Business Name): PARK PLACE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 COMMERCE ST
GRETNA LA
70056-7316
US

IV. Provider business mailing address

343 3RD ST STE 600
BATON ROUGE LA
70801-1309
US

V. Phone/Fax

Practice location:
  • Phone: 504-393-9595
  • Fax:
Mailing address:
  • Phone: 225-343-9154
  • Fax:

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: KRYSTAL HOWARD
Title or Position: EXECUTIVE TEAM
Credential:
Phone: 504-393-9595