Healthcare Provider Details

I. General information

NPI: 1477720456
Provider Name (Legal Business Name): WYNHOVEN HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 MEDICAL CENTER BLVD
MARRERO LA
70072-3144
US

IV. Provider business mailing address

1050 MEDICAL CENTER BLVD
MARRERO LA
70072-3144
US

V. Phone/Fax

Practice location:
  • Phone: 504-347-0777
  • Fax:
Mailing address:
  • Phone: 504-347-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number454
License Number StateLA

VIII. Authorized Official

Name: JANE FOCKLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 504-347-0777