Healthcare Provider Details

I. General information

NPI: 1356508667
Provider Name (Legal Business Name): VILLA FELICIANA MEDICAL COMPLEX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 HWY 10
JACKSON LA
70748-0438
US

IV. Provider business mailing address

PO BOX 438
JACKSON LA
70748-0438
US

V. Phone/Fax

Practice location:
  • Phone: 225-634-4017
  • Fax:
Mailing address:
  • Phone: 225-634-4017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number233
License Number StateLA

VIII. Authorized Official

Name: MR. JAMES R O REAR
Title or Position: LONG TERM CARE ADMIN
Credential:
Phone: 225-634-4017