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NPI Code Detail

MEDICARE: WINNSBORO OPCO LLC

MEDICARE: WINNSBORO OPCO LLC
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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1275180655
Entity Type Code : Organization
Provider Name (Legal Business Name) : WINNSBORO OPCO LLC
Provider Business Mailing Address
First Line : 8675 BLUEBONNET BLVD STE A
Second Line :
City : BATON ROUGE
State : LA
Zip : 70810-2976
Country : US
Telephone Number : 225-800-4954
Fax Number :
Provider Business Practice Location Address
First Line : 804 POLK ST
Second Line :
City : WINNSBORO
State : LA
Zip : 71295-2350
Country : US
Telephone Number : 318-435-6116
Fax Number : 318-435-3993
Authorized Official
Title or Position : MANAGER
Name : VICTOR DEVIN GUM
Credential :
Telephone Number : 225-800-4954
Provider Enumeration Date : 08/21/2019
Last Update Date : 08/23/2019

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Directions to “WINNSBORO OPCO LLC ” Practice Location

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