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General NPI Number Information
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NPI Number | 1275739997
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Entity Type | Organization
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Legal Business Name | MEDICAL MANAGEMENT ENTERPRISES
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 1238 N BARMAN AVE
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City | GONZALES
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State | LA
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Zip | 70737-2440
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Country | US
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Telephone | 225-644-7994
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 819
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City | GONZALES
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State | LA
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Zip | 70707-0819
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Country | US
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Telephone | 225-644-7994
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY W. BORG
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Credential |
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Telephone | 225-644-7994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 483
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License Number State | LA
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