Provider Demographics
NPI:1356508667
Name:VILLA FELICIANA MEDICAL COMPLEX
Entity Type:Organization
Organization Name:VILLA FELICIANA MEDICAL COMPLEX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LONG TERM CARE ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:O REAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-634-4017
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:LA
Mailing Address - Zip Code:70748-0438
Mailing Address - Country:US
Mailing Address - Phone:225-634-4017
Mailing Address - Fax:
Practice Address - Street 1:5002 HWY 10
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:LA
Practice Address - Zip Code:70748-0438
Practice Address - Country:US
Practice Address - Phone:225-634-4017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA233314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA195150OtherMEDICARE SKILLED - ECF