Provider Demographics
NPI:1184275695
Name:DSRM OPCO LAFAYETTE LLC
Entity type:Organization
Organization Name:DSRM OPCO LAFAYETTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-812-2140
Mailing Address - Street 1:1905 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-4415
Mailing Address - Country:US
Mailing Address - Phone:318-812-2140
Mailing Address - Fax:
Practice Address - Street 1:103 W MARTIAL AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6719
Practice Address - Country:US
Practice Address - Phone:337-981-5335
Practice Address - Fax:337-981-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility