Pecan Grove Community Home

LBN: Provincial Community Home Inc
Pecan Grove Community Home is an health care organization with primary practice located at 167 Poole Road , Mansfield LA 71052-5007. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded, which is considered as the primary health care specialty. Provincial Community Home Inc can be contacted via phone (318) 872-0206, or through Terrell, Johnny Drew via phone (318) 872-0206.

Contact Information

Primary practice address
167 Poole Road Mansfield LA 71052-5007
Phone: (318) 872-0206
Fax: (318) 872-8833
Website:
Map and Directions
Authorized official contact:
Name: Terrell, Johnny Drew
Phone: (318) 872-0206

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded 315P00000X 636 Louisiana

Profile Details

NPI number 1780894477
LBN Legal business name Provincial Community Home Inc
DBA Doing business as Pecan Grove Community Home
Authorized official Terrell, Johnny Drew
Entity Organization
Organization subpart 1 No
Enumeration date May 23rd, 2007
Last updated Aug 22nd, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780894477 NPPES
Louisiana MEDICAID 1718971

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