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General NPI Number Information
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NPI Number | 1568514974
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Entity Type | Organization
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Legal Business Name | OAK PARK HEALTH CARE CENTER, LLC
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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 | 2335 OAK PARK BLVD
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City | LAKE CHARLES
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State | LA
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Zip | 70601-7970
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Country | US
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Telephone | 337-478-2920
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Fax | 337-479-1512
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Provider Business Mailing Address
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Address Line | 2335 OAK PARK BLVD
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City | LAKE CHARLES
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State | LA
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Zip | 70601-7970
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Country | US
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Telephone | 337-478-2920
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Fax | 337-479-1512
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. 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 | 841
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License Number State | LA
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