Provider Demographics
NPI:1902250129
Name:TANGI PINES SENIOR CARE, L.L.C
Entity Type:Organization
Organization Name:TANGI PINES SENIOR CARE, L.L.C
Other - Org Name:TANGI PINES NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KALEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-748-9464
Mailing Address - Street 1:10746 HWY 16
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422
Mailing Address - Country:US
Mailing Address - Phone:985-748-9464
Mailing Address - Fax:985-748-4404
Practice Address - Street 1:709 E NORTH PL
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2307
Practice Address - Country:US
Practice Address - Phone:985-748-9464
Practice Address - Fax:985-748-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA834314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA834OtherDHH LICENSE
LA834OtherDHH LICENSE