Provider Demographics
NPI:1538117122
Name:OAKS OF HOUMA COMMUNITY CARE CENTER LLC
Entity Type:Organization
Organization Name:OAKS OF HOUMA COMMUNITY CARE CENTER LLC
Other - Org Name:THE OAKS OF HOUMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-709-1408
Mailing Address - Street 1:1701 POLK ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-6071
Mailing Address - Country:US
Mailing Address - Phone:985-876-5692
Mailing Address - Fax:985-868-1954
Practice Address - Street 1:1701 POLK ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-6071
Practice Address - Country:US
Practice Address - Phone:985-876-5692
Practice Address - Fax:985-868-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1510130Medicaid
LA30597OtherBLUE CROSS BLUE SHIELD
LA30597OtherBLUE CROSS BLUE SHIELD