Healthcare Provider Details

I. General information

NPI: 1396344941
Provider Name (Legal Business Name): MINDEN COMMUNITY CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 WESTON ST
MINDEN LA
71055-3660
US

IV. Provider business mailing address

614 WESTON ST
MINDEN LA
71055-3660
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-5148
  • Fax:
Mailing address:
  • Phone: 318-377-5148
  • 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: TONI H PARKINSON
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 601-709-1408