Organization
COMMUNITY CARE CENTER OF MANDEVILLE LLC
Active
Other names
Heritage Manor of Mandeville
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TONI PARKINSON (AUTHORIZED OFFICIAL)
(601) 709-1408
Entity
Organization
Contact information
Practice address
1820 W CAUSEWAY APPROACH, MANDEVILLE, LA 70471-2960
(985) 626-4798
(985) 626-3878
Mailing address
1820 W CAUSEWAY APPROACH, MANDEVILLE, LA 70471-2960
(985) 626-4798
(985) 626-3878
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
764
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1521337
—
LA
01
—
31043
BLUE CROSS BLUE SHIELD
LA
Enumeration date
05/02/2006
Last updated
11/17/2020
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