Healthcare Provider Details

I. General information

NPI: 1750349452
Provider Name (Legal Business Name): COMMUNITY CARE CENTER OF VILLE PLATTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 11/30/2024
Certification Date: 11/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W MAIN ST
VILLE PLATTE LA
70586-2830
US

IV. Provider business mailing address

2020 W MAIN ST
VILLE PLATTE LA
70586-2830
US

V. Phone/Fax

Practice location:
  • Phone: 337-363-5532
  • Fax: 337-363-6275
Mailing address:
  • Phone: 337-363-5532
  • Fax: 337-363-6275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number795
License Number StateLA

VIII. Authorized Official

Name: MRS. TONI PARKINSON
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 601-709-1408