MEDICARE: PLANTATION MANAGEMENT COMPANY, 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

General Provider Information

NPI Number	:	1659497048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLANTATION MANAGEMENT COMPANY, LLC

Provider Business Mailing Address
First Line	:	301 VETERANS BLVD
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4722
Country	:	US
Telephone Number	:	225-664-6697
Fax Number	:	225-665-0510

Provider Business Practice Location Address
First Line	:	301 VETERANS BLVD
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4722
Country	:	US
Telephone Number	:	225-664-6697
Fax Number	:	225-665-0510

Authorized Official
Title or Position	:	COMPTROLLER
Name	:	KIMBERLY W DELATTE
Credential	:	CPA
Telephone Number	:	225-664-6697

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/22/2020

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