Healthcare Provider Details

I. General information

NPI: 1568462166
Provider Name (Legal Business Name): CALCASIEU MULTI HANDICAPPED CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 INDUSTRIAL ST
VINTON LA
70668-4537
US

IV. Provider business mailing address

1301 INDUSTRIAL ST
VINTON LA
70668-4537
US

V. Phone/Fax

Practice location:
  • Phone: 337-589-3444
  • Fax: 337-589-5337
Mailing address:
  • Phone: 337-589-3444
  • Fax: 337-589-5337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number128
License Number StateLA

VIII. Authorized Official

Name: ELIZABETH FELLOWS
Title or Position: CEO
Credential:
Phone: 816-444-0900