Healthcare Provider Details

I. General information

NPI: 1114651601
Provider Name (Legal Business Name): LLC-II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 E PRUDHOMME ST FL 6
OPELOUSAS LA
70570-6499
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-5184
  • Fax: 337-948-3294
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-443-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS GACHASSIN III
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 337-233-1307