Healthcare Provider Details

I. General information

NPI: 1902575426
Provider Name (Legal Business Name): LANDMARK OF RAYNE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 CROWLEY RAYNE HWY
RAYNE LA
70578-4027
US

IV. Provider business mailing address

2021 CROWLEY RAYNE HWY
RAYNE LA
70578-4027
US

V. Phone/Fax

Practice location:
  • Phone: 337-783-8108
  • Fax: 337-783-9476
Mailing address:
  • Phone: 337-783-8108
  • Fax: 337-783-9476

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: MS. TONI H PARKINSON
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 601-709-1408