MEDICARE: OAK PARK HEALTH CARE CENTER, 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
1	314000000X	Skilled Nursing Facility	841	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	:	1568514974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK PARK HEALTH CARE CENTER, LLC

Provider Business Mailing Address
First Line	:	2335 OAK PARK BLVD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7970
Country	:	US
Telephone Number	:	337-478-2920
Fax Number	:	337-479-1512

Provider Business Practice Location Address
First Line	:	2335 OAK PARK BLVD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7970
Country	:	US
Telephone Number	:	337-478-2920
Fax Number	:	337-479-1512

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. BOB G. DEAN JR.
Credential	:
Telephone Number	:	225-343-9152

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	06/29/2009

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