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NPI Code Detail

MEDICARE: WEST CARROLL CARE CENTER INC

MEDICARE: WEST CARROLL CARE CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1313M00000XNursing Facility/Intermediate Care Facility467LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114900099
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST CARROLL CARE CENTER INC
Provider Business Mailing Address
First Line : 706 ROSS ST
Second Line :
City : OAK GROVE
State : LA
Zip : 71263-9798
Country : US
Telephone Number : 318-428-9612
Fax Number : 318-428-6185
Provider Business Practice Location Address
First Line : 706 ROSS ST
Second Line :
City : OAK GROVE
State : LA
Zip : 71263-9798
Country : US
Telephone Number : 318-428-9612
Fax Number : 318-428-6185
Authorized Official
Title or Position : ADMINISTRATOR
Name : DEWANA LITTLE
Credential :
Telephone Number : 318-428-9612
Provider Enumeration Date : 11/23/2005
Last Update Date : 04/11/2011

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1770543464 — WEST CARROLL MEMORIAL HOSPITAL
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1134186133 — FAKHRE FAKHRE M.D.
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1528025525 — ABIODUN O KUKU M.D.
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Directions to “WEST CARROLL CARE CENTER INC ” Practice Location

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