Provider Demographics
NPI:1902575426
Name:LANDMARK OF RAYNE LLC
Entity Type:Organization
Organization Name:LANDMARK OF RAYNE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:H
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-709-1408
Mailing Address - Street 1:2021 CROWLEY RAYNE HWY
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-4027
Mailing Address - Country:US
Mailing Address - Phone:337-783-8108
Mailing Address - Fax:337-783-9476
Practice Address - Street 1:2021 CROWLEY RAYNE HWY
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-4027
Practice Address - Country:US
Practice Address - Phone:337-783-8108
Practice Address - Fax:337-783-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1517658Medicaid