Organization
RIVERLANDS HOME GROUP, LLC
Active
Other names
Chateau St. James Rehab and Retirement
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN D BOULWARE (AUTHORIZED REPRESENTATIVE)
(985) 855-4424
Entity
Organization
Contact information
Practice address
1980 RIVER ROAD, LUTCHER, LA 70071
(225) 869-5725
(225) 869-4009
Mailing address
1980 RIVER ROAD, LUTCHER, LA 70071
(225) 869-5725
(225) 869-4009
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1017
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31201
BLUE CROSS BLUE SHIELD
LA
Enumeration date
06/17/2006
Last updated
07/31/2012
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