=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770129967
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANKLIN OPCO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2019
-----------------------------------------------------
Last Update Date | 03/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1907 CHINABERRY ST
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70538-5236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-828-1918
-----------------------------------------------------
Fax | 337-828-3650
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1907 CHINABERRY ST
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70538-5236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-828-1918
-----------------------------------------------------
Fax | 337-828-3650
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | V. DEVIN GUM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-800-4954
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------