Provider Demographics
NPI:1710909569
Name:CHARLYN ENTERPRISES, LLC
Entity Type:Organization
Organization Name:CHARLYN ENTERPRISES, LLC
Other - Org Name:CHARLYN REHABILITATION & NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING FACILITY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-435-6116
Mailing Address - Street 1:804 POLK ST
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-2350
Mailing Address - Country:US
Mailing Address - Phone:318-435-6116
Mailing Address - Fax:318-435-3993
Practice Address - Street 1:804 POLK ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-2350
Practice Address - Country:US
Practice Address - Phone:318-435-6116
Practice Address - Fax:318-435-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA893314000000X, 332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1514926Medicaid
LA195392Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
LA1514926Medicaid