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General NPI Number Information
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NPI Number | 1366594798
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Entity Type | Organization
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Legal Business Name | MAISON DEVILLE NURSING HOME OF OPELOUSAS, INC.
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 06/29/2009
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Provider Practice Location Address
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Address Line | 7941 I-49 SOUTH SERVICE ROAD
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City | OPELOUSAS
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State | LA
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Zip | 70570
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Country | US
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Telephone | 337-942-7588
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Fax |
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Provider Business Mailing Address
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Address Line | 7941 I-49 SOUTH SERVICE ROAD
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City | OPELOUSAS
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State | LA
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Zip | 70570
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Country | US
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Telephone | 337-942-7588
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BOB G. DEAN JR.
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Credential |
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Telephone | 225-343-9152
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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 | 213
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License Number State | LA
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