Organization
DIVERSIFIED HEALTH CARE-LAKE CHARLES, LLC
Active
Other names
LAKE CHARLES CARE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMIE H GROCE (ACCOUNTING MANAGER)
(337) 439-0336
Entity
Organization
Contact information
Practice address
2701 ERNEST ST, LAKE CHARLES, LA 70601-8406
(337) 439-0336
(337) 494-0546
Mailing address
2701 ERNEST ST, LAKE CHARLES, LA 70601-8406
(337) 439-0336
(337) 494-0546
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
799
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1510114
—
LA
Enumeration date
08/09/2005
Last updated
01/26/2010
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