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General NPI Number Information
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NPI Number | 1023075355
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE CENTER OF THIBODAUX LLC
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Dates
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Enumeration Date | 04/28/2006
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Last Update Date | 11/30/2024
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Provider Practice Location Address
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Address Line | 2110 AUDUBON AVE
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City | THIBODAUX
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State | LA
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Zip | 70301-5014
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Country | US
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Telephone | 985-446-3975
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Fax | 985-447-5329
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Provider Business Mailing Address
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Address Line | 2110 AUDUBON AVE
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City | THIBODAUX
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State | LA
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Zip | 70301-5014
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Country | US
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Telephone | 985-446-3975
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Fax | 985-447-5329
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Authorized Official
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Title or Position | AUTHORIZED REPRESENTATIVE
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Name | MS. TONI PARKINSON
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Credential |
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Telephone | 601-709-1408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 766
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License Number State | LA
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