Healthcare Provider Details

I. General information

NPI: 1932196581
Provider Name (Legal Business Name): CHARLYN ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 POLK ST
WINNSBORO LA
71295-2350
US

IV. Provider business mailing address

804 POLK ST
WINNSBORO LA
71295-2350
US

V. Phone/Fax

Practice location:
  • Phone: 318-435-6116
  • Fax: 318-435-3993
Mailing address:
  • Phone: 318-435-6116
  • Fax: 318-435-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number893
License Number StateLA

VIII. Authorized Official

Name: MR. JEREMY PAUL LEDET
Title or Position: ACCOUNTANT
Credential:
Phone: 318-574-5230