Provider Demographics
NPI:1356490049
Name:DIVERSIFIED HEALTHCARE ABBEVILLE, LLC
Entity Type:Organization
Organization Name:DIVERSIFIED HEALTHCARE ABBEVILLE, LLC
Other - Org Name:MAISON DU MONDE LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:BREAUX
Authorized Official - Suffix:JR
Authorized Official - Credentials:NFA
Authorized Official - Phone:337-892-2332
Mailing Address - Street 1:4000 RODEO RD.
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510
Mailing Address - Country:US
Mailing Address - Phone:337-892-2332
Mailing Address - Fax:337-893-5438
Practice Address - Street 1:4000 RODEO RD.
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510
Practice Address - Country:US
Practice Address - Phone:337-892-2332
Practice Address - Fax:337-893-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA891314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1521876Medicaid
LA1521876Medicaid