Provider Demographics
NPI:1750451480
Name:LAFAYETTE EXTENDED CARE,L.L.C
Entity Type:Organization
Organization Name:LAFAYETTE EXTENDED CARE,L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN.
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-864-8854
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36862-0152
Mailing Address - Country:US
Mailing Address - Phone:334-864-8854
Mailing Address - Fax:334-864-8851
Practice Address - Street 1:805 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:AL
Practice Address - Zip Code:36862-2817
Practice Address - Country:US
Practice Address - Phone:334-864-8854
Practice Address - Fax:334-864-8851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12494314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4755600SMedicaid
AL4755600SMedicaid