Provider Demographics
NPI:1093773301
Name:COMMUNITY CARE CENTER OF ST MARTINVILLE LLC
Entity Type:Organization
Organization Name:COMMUNITY CARE CENTER OF ST MARTINVILLE LLC
Other - Org Name:LANDMARK OF ACADIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-709-1408
Mailing Address - Street 1:1710 SMEDE HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582-7703
Mailing Address - Country:US
Mailing Address - Phone:337-394-6044
Mailing Address - Fax:337-394-7044
Practice Address - Street 1:1710 SMEDE HWY
Practice Address - Street 2:
Practice Address - City:SAINT MARTINVILLE
Practice Address - State:LA
Practice Address - Zip Code:70582
Practice Address - Country:US
Practice Address - Phone:337-394-6044
Practice Address - Fax:337-394-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA783314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1521442Medicaid
LA31058OtherBLUE CROSS BLUE SHIELD
LA195487Medicare Oscar/Certification