Healthcare Provider Details

I. General information

NPI: 1104745785
Provider Name (Legal Business Name): SIMMESPORT OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16232 HIGHWAY 1
SIMMESPORT LA
71369-2156
US

IV. Provider business mailing address

2431 S ACADIAN THRUWAY STE 100
BATON ROUGE LA
70808-2300
US

V. Phone/Fax

Practice location:
  • Phone: 318-941-2294
  • Fax:
Mailing address:
  • Phone: 225-800-4954
  • Fax:

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: MR. VICTOR D. GUM
Title or Position: MANAGER
Credential:
Phone: 225-800-4954