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General NPI Number Information
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NPI Number | 1124135827
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Entity Type | Organization
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Legal Business Name | LAFAYETTE LTC, INC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 1301 BELK BLVD
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City | OXFORD
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State | MS
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Zip | 38655-5301
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Country | US
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Telephone | 662-234-7821
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Fax | 662-234-0294
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Provider Business Mailing Address
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Address Line | 1301 BELK BLVD
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City | OXFORD
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State | MS
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Zip | 38655-5301
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Country | US
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Telephone | 662-234-7821
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Fax | 662-234-0294
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Authorized Official
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Title or Position | OWNER
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Name | MR. GENE BENNETT HUBBARD JR.
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Credential |
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Telephone | 601-849-2294
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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 | 185
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License Number State | MS
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