Provider Demographics
NPI:1750349452
Name:COMMUNITY CARE CENTER OF VILLE PLATTE LLC
Entity type:Organization
Organization Name:COMMUNITY CARE CENTER OF VILLE PLATTE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:2020 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-2830
Mailing Address - Country:US
Mailing Address - Phone:337-363-5532
Mailing Address - Fax:337-363-6275
Practice Address - Street 1:2020 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-2830
Practice Address - Country:US
Practice Address - Phone:337-363-5532
Practice Address - Fax:337-363-6275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA795314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3747P1801XOtherPERSONAL CARE ATTENDNT
LA385H00000XOtherRESPITE CARE
LA1510050Medicaid
LA30831OtherBLUE CROSS BLUE SHIELD
LA195507Medicare Oscar/Certification