Provider Demographics
NPI:1457856775
Name:CAMERON OPCO LLC
Entity Type:Organization
Organization Name:CAMERON OPCO LLC
Other - Org Name:LEGACY NURSING AND REHABILITATION
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 1:2431 S ACADIAN THRUWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-2300
Mailing Address - Country:US
Mailing Address - Phone:225-800-4954
Mailing Address - Fax:225-308-2278
Practice Address - Street 1:2202 N TRAVIS AVE
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:TX
Practice Address - Zip Code:76520
Practice Address - Country:US
Practice Address - Phone:254-697-6564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility