Organization
PONCHATOULA NURSING HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL GUITREAU (OWNER)
(985) 542-0110
Entity
Organization
Contact information
Practice address
15704 MEDICAL ARTS DR, HAMMOND, LA 70403-1446
(985) 542-0110
Mailing address
PO BOX 13524, ALEXANDRIA, LA 71315-3524
(318) 445-4477
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1163163
—
LA
01
—
34086
BLUE CROSS BLUE SHIELD
LA
Enumeration date
04/12/2007
Last updated
08/22/2020
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