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General NPI Number Information
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NPI Number | 1104745785
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Entity Type | Organization
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Legal Business Name | SIMMESPORT OPCO, LLC
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 16232 HIGHWAY 1
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City | SIMMESPORT
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State | LA
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Zip | 71369-2156
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Country | US
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Telephone | 318-941-2294
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Fax |
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Provider Business Mailing Address
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Address Line | 2431 S ACADIAN THRUWAY STE 100
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City | BATON ROUGE
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State | LA
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Zip | 70808-2300
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Country | US
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Telephone | 225-800-4954
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. VICTOR D. GUM
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Credential |
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Telephone | 225-800-4954
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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 |
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License Number State |
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