Provider Demographics
NPI:1942258876
Name:COMMUNITY CARE CENTER OF COVINGTON LLC
Entity Type:Organization
Organization Name:COMMUNITY CARE CENTER OF COVINGTON LLC
Other - Org Name:FOREST MANOR NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MRS
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 1:1330 OCHSNER BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8172
Mailing Address - Country:US
Mailing Address - Phone:985-892-6900
Mailing Address - Fax:985-892-7857
Practice Address - Street 1:1330 OCHSNER BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8172
Practice Address - Country:US
Practice Address - Phone:985-892-6900
Practice Address - Fax:985-892-7857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA776314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1521361Medicaid
LA30901OtherBC/BS
LA30901OtherBC/BS