Provider Demographics
NPI:1407972227
Name:SACRED HEART MANAGEMENT LLC
Entity Type:Organization
Organization Name:SACRED HEART MANAGEMENT LLC
Other - Org Name:SACRED HEART MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-305-0717
Mailing Address - Street 1:15171 S HARRELLS FERRY RD STE C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2980
Mailing Address - Country:US
Mailing Address - Phone:337-639-2934
Mailing Address - Fax:337-639-4373
Practice Address - Street 1:417 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:LA
Practice Address - Zip Code:70655-3519
Practice Address - Country:US
Practice Address - Phone:337-639-2934
Practice Address - Fax:337-639-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility