Provider Demographics
NPI:1518236884
Name:BAYOU VISTA NURSING AND REHAB CENTER
Entity Type:Organization
Organization Name:BAYOU VISTA NURSING AND REHAB CENTER
Other - Org Name:BAYOU VISTA NURSING AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:BONNETTE
Authorized Official - Last Name:PEPITON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-922-3404
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:BUNKIE
Mailing Address - State:LA
Mailing Address - Zip Code:71322-0270
Mailing Address - Country:US
Mailing Address - Phone:318-346-2080
Mailing Address - Fax:318-346-7879
Practice Address - Street 1:323 EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:BUNKIE
Practice Address - State:LA
Practice Address - Zip Code:71322-1307
Practice Address - Country:US
Practice Address - Phone:318-346-2080
Practice Address - Fax:318-346-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1511994Medicaid
LA1511994Medicaid