# COMMUNITY CARE CENTER OF THIBODAUX LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023075355
- **Authorized official:** MS. TONI PARKINSON (AUTHORIZED REPRESENTATIVE)
- **Authorized official phone:** (601) 709-1408

## Contact information

- **Practice address:** 2110 AUDUBON AVE, THIBODAUX, LA 70301-5014
- **Practice address phone:** (985) 446-3975
- **Practice address fax:** (985) 447-5329
- **Mailing address:** 2110 AUDUBON AVE, THIBODAUX, LA 70301-5014
- **Mailing address phone:** (985) 446-3975
- **Mailing address fax:** (985) 447-5329

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 766 | LA | Yes |

## Other

- **Enumeration date:** 04/28/2006
- **Last updated:** 11/30/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1521311 | — | LA |