Healthcare Provider Details

I. General information

NPI: 1407972227
Provider Name (Legal Business Name): SACRED HEART MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 INDUSTRIAL DR
OBERLIN LA
70655-3519
US

IV. Provider business mailing address

15171 S HARRELLS FERRY RD STE C
BATON ROUGE LA
70816-2980
US

V. Phone/Fax

Practice location:
  • Phone: 337-639-2934
  • Fax: 337-639-4373
Mailing address:
  • Phone: 337-639-2934
  • Fax: 337-639-4373

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: SCOTT R BROUSSARD
Title or Position: MEMBER
Credential:
Phone: 337-305-0717