Provider Demographics
NPI:1871541722
Name:COMMUNITY CARE CENTER OF BATON ROUGE LLC
Entity type:Organization
Organization Name:COMMUNITY CARE CENTER OF BATON ROUGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-709-1408
Mailing Address - Street 1:18180 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-7423
Mailing Address - Country:US
Mailing Address - Phone:225-292-8474
Mailing Address - Fax:225-292-5350
Practice Address - Street 1:18180 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-7423
Practice Address - Country:US
Practice Address - Phone:225-292-8474
Practice Address - Fax:225-292-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA778314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA30699OtherBLUE CROSS BLUE SHIELD
LA1521353Medicaid
LA195480Medicare Oscar/Certification