Organization
PORT ALLEN CARE CENTER, LLC
Active
Other names
Legacy Nursing and Rehabilitation of Port Allen
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VICTOR D GUM (MANAGER)
(225) 800-4955
Entity
Organization
Contact information
Practice address
403 N 15TH ST, PORT ALLEN, LA 70767-2264
(225) 346-8815
(225) 346-8989
Mailing address
403 N 15TH ST, PORT ALLEN, LA 70767-2264
(225) 346-8815
(225) 346-8989
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
385
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1520039
—
LA
Enumeration date
09/22/2006
Last updated
04/29/2019
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