Healthcare Provider Details

I. General information

NPI: 1023110897
Provider Name (Legal Business Name): WOLDENBERG VILLAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 BERHMAN PLACE
NEW ORLEANS LA
70114
US

IV. Provider business mailing address

3701 BEHRMAN PLACE
NEW ORLEANS LA
70114
US

V. Phone/Fax

Practice location:
  • Phone: 504-367-5640
  • Fax: 504-367-5643
Mailing address:
  • Phone: 504-367-5640
  • Fax: 504-367-5643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number161
License Number StateLA

VIII. Authorized Official

Name: JOSEPH TOWNSEND
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 504-367-5640