Provider Demographics
NPI:1376863597
Name:CHICOT OPERATIONS, LLC
Entity Type:Organization
Organization Name:CHICOT OPERATIONS, LLC
Other - Org Name:LAKE VILLAGE REHABILITATION AND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-265-5337
Mailing Address - Street 1:PO BOX 12187
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-2187
Mailing Address - Country:US
Mailing Address - Phone:870-265-5337
Mailing Address - Fax:870-265-3275
Practice Address - Street 1:903 BORGOGNONI DR
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-1623
Practice Address - Country:US
Practice Address - Phone:870-265-5337
Practice Address - Fax:870-265-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR045184Medicare Oscar/Certification