Healthcare Provider Details

I. General information

NPI: 1376210575
Provider Name (Legal Business Name): 2707 LAF SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 KALISTE SALOOM RD
LAFAYETTE LA
70508-7139
US

IV. Provider business mailing address

2100 VEROT SCHOOL RD STE 4
LAFAYETTE LA
70508-6466
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-2258
  • Fax:
Mailing address:
  • Phone: 337-270-9090
  • Fax: 337-270-9091

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: CHAD MOODY
Title or Position: MANAGER
Credential:
Phone: 337-270-9090