Provider Demographics
NPI:1275180655
Name:WINNSBORO OPCO LLC
Entity Type:Organization
Organization Name:WINNSBORO OPCO LLC
Other - Org Name:LEGACY NURSING AND REHABILITATION OF WINNSBORO
Other - Org Type:Doing Business As
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 1:8675 BLUEBONNET BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2976
Mailing Address - Country:US
Mailing Address - Phone:225-800-4954
Mailing Address - Fax:
Practice Address - Street 1:804 POLK ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-2350
Practice Address - Country:US
Practice Address - Phone:318-435-6116
Practice Address - Fax:318-435-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility