Provider Demographics
NPI:1932253549
Name:ST FRANCISVILLE COUNTRY MANOR LLC
Entity Type:Organization
Organization Name:ST FRANCISVILLE COUNTRY MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:T
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:225-635-3346
Mailing Address - Street 1:15243 LA HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-4752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15243 LA HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775-4752
Practice Address - Country:US
Practice Address - Phone:225-635-3346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA735313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1521078Medicaid
LA1521078Medicaid