MEDICARE: FC2013, L.L.C.

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
1	314000000X	Skilled Nursing Facility		LA

Other Identifiers

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

General Provider Information

NPI Number	:	1487090254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FC2013, L.L.C.

Provider Business Mailing Address
First Line	:	PO BOX 800
Second Line	:	11429 FERDINAND
City	:	SAINT FRANCISVILLE
State	:	LA
Zip	:	70775-0800
Country	:	US
Telephone Number	:	225-927-4290
Fax Number	:	225-927-5385

Provider Business Practice Location Address
First Line	:	14500 HAYNE BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70128-1751
Country	:	US
Telephone Number	:	225-927-4290
Fax Number	:	225-927-5385

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. DANIEL D. BROWN
Credential	:
Telephone Number	:	225-927-4290

Provider Enumeration Date	:	05/20/2013
Last Update Date	:	05/20/2013

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