Healthcare Provider Details

I. General information

NPI: 1598723769
Provider Name (Legal Business Name): PLAQUEMINE CARING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59215 RIVER WEST DR
PLAQUEMINE LA
70764-6552
US

IV. Provider business mailing address

59215 RIVER WEST DR
PLAQUEMINE LA
70764-6552
US

V. Phone/Fax

Practice location:
  • Phone: 225-687-0240
  • Fax: 225-687-0249
Mailing address:
  • Phone: 225-687-0240
  • Fax: 225-687-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number441
License Number StateLA

VIII. Authorized Official

Name: MR. VICTOR D. GUM
Title or Position: MANAGER
Credential:
Phone: 225-800-4955