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General NPI Number Information
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NPI Number | 1356490049
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED HEALTHCARE ABBEVILLE, LLC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 4000 RODEO RD.
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City | ABBEVILLE
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State | LA
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Zip | 70510
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Country | US
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Telephone | 337-892-2332
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Fax | 337-893-5438
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Provider Business Mailing Address
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Address Line | 4000 RODEO RD.
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City | ABBEVILLE
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State | LA
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Zip | 70510
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Country | US
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Telephone | 337-892-2332
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Fax | 337-893-5438
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. AL BREAUX JR.
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Credential | NFA
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Telephone | 337-892-2332
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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 | 891
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License Number State | LA
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