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NPI Code Detail

MEDICARE: CHARLYN ENTERPRISES, LLC

MEDICARE: CHARLYN ENTERPRISES, 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
1332BN1400XNursing Facility Supplies (DME)893LA
2332BP3500XParenteral & Enteral Nutrition Supplies (DME)893LA
3314000000XSkilled Nursing Facility893LA

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 : 1710909569
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARLYN ENTERPRISES, LLC
Provider Business Mailing 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
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 : NURSING FACILITY ADMINISTRATOR
Name : MR. DONALD WAYNE HENDERSON
Credential :
Telephone Number : 318-435-6116
Provider Enumeration Date : 07/24/2006
Last Update Date : 06/13/2011

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71295-2350
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Directions to “CHARLYN ENTERPRISES, LLC ” Practice Location

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