Healthcare Provider Details

I. General information

NPI: 1083715841
Provider Name (Legal Business Name): LLC-I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 KEYSER AVE 4TH FLOOR
NATCHITOCHES LA
71457-6018
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 318-354-2044
  • Fax: 318-354-2041
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-233-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. MARCUS D. MACIP
Title or Position: VICE PRESIDENT
Credential:
Phone: 337-233-1307