Provider Demographics
NPI:1083037733
Name:DHC OPCO-PINEVILLE, LLC
Entity Type:Organization
Organization Name:DHC OPCO-PINEVILLE, LLC
Other - Org Name:ST. CHRISTINA NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:M
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-456-8500
Mailing Address - Street 1:210 MAGNATE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3871
Mailing Address - Country:US
Mailing Address - Phone:337-456-8500
Mailing Address - Fax:318-448-9772
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:318-448-9772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA888314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1510939Medicaid
LA195613Medicare Oscar/Certification