Healthcare Provider Details

I. General information

NPI: 1063487528
Provider Name (Legal Business Name): LANDRY ROAD INVESTMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 ERASTE LANDRY RD
LAFAYETTE LA
70506-3054
US

IV. Provider business mailing address

1005 ERASTE LANDRY RD
LAFAYETTE LA
70506-3054
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-6370
  • Fax: 337-266-2071
Mailing address:
  • Phone: 337-232-6370
  • Fax: 337-266-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number906
License Number StateLA

VIII. Authorized Official

Name: MR. JOHN E JUMONVILLE
Title or Position: OWNER
Credential:
Phone: 337-232-6370