Provider Demographics
NPI:1477720456
Name:WYNHOVEN HEALTHCARE CENTER
Entity Type:Organization
Organization Name:WYNHOVEN HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-347-0777
Mailing Address - Street 1:1050 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3144
Mailing Address - Country:US
Mailing Address - Phone:504-347-0777
Mailing Address - Fax:
Practice Address - Street 1:1050 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3144
Practice Address - Country:US
Practice Address - Phone:504-347-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA454314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1378577Medicaid