Provider Demographics
NPI:1558906370
Name:AUDUBON RETIREMENT VILLAGE, INC.
Entity Type:Organization
Organization Name:AUDUBON RETIREMENT VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AYAME
Authorized Official - Middle Name:
Authorized Official - Last Name:DINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-894-5462
Mailing Address - Street 1:950 W CAUSEWAY APPROACH
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3082
Mailing Address - Country:US
Mailing Address - Phone:504-324-8950
Mailing Address - Fax:985-624-3477
Practice Address - Street 1:612 HENRY CLAY AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5818
Practice Address - Country:US
Practice Address - Phone:504-896-5900
Practice Address - Fax:504-896-5982
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUDUBON RETIREMENT VILLAGE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-15
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2473735Medicaid