Provider Demographics
NPI:1780621193
Name:PLANTATION MANAGEMENT COMPANY, LLC
Entity type:Organization
Organization Name:PLANTATION MANAGEMENT COMPANY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DELATTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-664-6697
Mailing Address - Street 1:301 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4722
Mailing Address - Country:US
Mailing Address - Phone:985-345-7210
Mailing Address - Fax:985-345-7199
Practice Address - Street 1:1300 DEREK DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5765
Practice Address - Country:US
Practice Address - Phone:985-345-7210
Practice Address - Fax:985-345-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA724314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1521019Medicaid
LA195526Medicare Oscar/Certification
LA195526Medicare ID - Type UnspecifiedPROVIDER NUMBER