Provider Demographics
NPI:1912922147
Name:AVOYELLES MANOR, INC.
Entity Type:Organization
Organization Name:AVOYELLES MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPITON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-922-3404
Mailing Address - Street 1:5682 HIGHWAY 107
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:LA
Mailing Address - Zip Code:71329
Mailing Address - Country:US
Mailing Address - Phone:318-922-3404
Mailing Address - Fax:318-922-3680
Practice Address - Street 1:5682 HWY 107 SOUTH
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:LA
Practice Address - Zip Code:71329
Practice Address - Country:US
Practice Address - Phone:318-922-3404
Practice Address - Fax:318-922-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA240314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1514951Medicaid
LA190031190ZOtherPROVIDER NUMBER
LA195580Medicare Oscar/Certification