Provider Demographics
NPI:1144553603
Name:VERSAILLES HEALTHCARE LLC
Entity type:Organization
Organization Name:VERSAILLES HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER REPRESENTATIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:STALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-956-8884
Mailing Address - Street 1:5100 JACKSON STREET EXT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2317
Mailing Address - Country:US
Mailing Address - Phone:318-445-5215
Mailing Address - Fax:318-442-8067
Practice Address - Street 1:5100 JACKSON STREET EXT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2317
Practice Address - Country:US
Practice Address - Phone:318-445-5215
Practice Address - Fax:318-442-8067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA385H00000XOtherRESPITE CARE
LA1514624Medicaid
LA195600Medicare Oscar/Certification