Provider Demographics
NPI:1003691932
Name:ST CHRISTINA OPCO LLC
Entity Type:Organization
Organization Name:ST CHRISTINA OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:DEVIN
Authorized Official - Last Name:GUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-800-4954
Mailing Address - Street 1:2431 S ACADIAN THRUWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-2300
Mailing Address - Country:US
Mailing Address - Phone:225-800-4954
Mailing Address - Fax:
Practice Address - Street 1:122 HILLSDALE DR
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6856
Practice Address - Country:US
Practice Address - Phone:318-448-0141
Practice Address - Fax:318-314-2008
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LP2 HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility