Provider Demographics
NPI:1962469213
Name:COMMUNITY CARE CENTER OF HERITAGE HOUSE LLC
Entity Type:Organization
Organization Name:COMMUNITY CARE CENTER OF HERITAGE HOUSE LLC
Other - Org Name:HERITAGE MANOR OF BATON ROUGE II
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 1:9301 OXFORD PLACE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2557
Mailing Address - Country:US
Mailing Address - Phone:225-924-2851
Mailing Address - Fax:225-924-2975
Practice Address - Street 1:9301 OXFORD PLACE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2557
Practice Address - Country:US
Practice Address - Phone:225-924-2851
Practice Address - Fax:225-924-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2019-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA777314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA385H00000XOtherRESPITE CARE
LA31048OtherBC/BS
LA1521370Medicaid
LA1521370Medicaid