Organization
MEDICAL MANAGEMENT ENTERPRISES
Active
Other names
Pennville Community Home
Organization subpart
No
Provider details
NPI number
Authorized official
GARY W. BORG (PRESIDENT)
(225) 644-7994
Entity
Organization
Contact information
Practice address
1238 N BARMAN AVE, GONZALES, LA 70737-2440
(225) 644-7994
Mailing address
PO BOX 819, GONZALES, LA 70707-0819
(225) 644-7994
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
483
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1717223
—
LA
Enumeration date
06/21/2007
Last updated
09/03/2013
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