# COMMUNITY CARE CENTER OF MANDEVILLE LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Heritage Manor of Mandeville
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679531362
- **Authorized official:** MS. TONI PARKINSON (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (601) 709-1408

## Contact information

- **Practice address:** 1820 W CAUSEWAY APPROACH, MANDEVILLE, LA 70471-2960
- **Practice address phone:** (985) 626-4798
- **Practice address fax:** (985) 626-3878
- **Mailing address:** 1820 W CAUSEWAY APPROACH, MANDEVILLE, LA 70471-2960
- **Mailing address phone:** (985) 626-4798
- **Mailing address fax:** (985) 626-3878

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 764 | LA | Yes |

## Other

- **Enumeration date:** 05/02/2006
- **Last updated:** 11/17/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1521337 | — | LA |
| 01 | — | 31043 | BLUE CROSS BLUE SHIELD | LA |