# DIVERSIFIED HEALTH CARE-LAKE CHARLES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LAKE CHARLES CARE CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598766941
- **Authorized official:** MRS. TAMMIE H GROCE (ACCOUNTING MANAGER)
- **Authorized official phone:** (337) 439-0336

## Contact information

- **Practice address:** 2701 ERNEST ST, LAKE CHARLES, LA 70601-8406
- **Practice address phone:** (337) 439-0336
- **Practice address fax:** (337) 494-0546
- **Mailing address:** 2701 ERNEST ST, LAKE CHARLES, LA 70601-8406
- **Mailing address phone:** (337) 439-0336
- **Mailing address fax:** (337) 494-0546

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 799 | LA | Yes |

## Other

- **Enumeration date:** 08/09/2005
- **Last updated:** 01/26/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1510114 | — | LA |