Provider Demographics
NPI:1134325129
Name:MEDICAL MANAGEMENT ENTERPRISES INC
Entity Type:Organization
Organization Name:MEDICAL MANAGEMENT ENTERPRISES INC
Other - Org Name:NEW RIVER HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BORG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-644-7994
Mailing Address - Street 1:PO BOX 571
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70707-0571
Mailing Address - Country:US
Mailing Address - Phone:225-644-7994
Mailing Address - Fax:
Practice Address - Street 1:1729 S. PURPERA
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:225-644-7994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA708315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1719749Medicaid