NPIMap

Organization Active NPI

Port Allen Care Center, LLC

  • Skilled Nursing Facility
  • Port Allen, LA
National Provider Identifier
1063512903
Registry record updated Apr 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
385 Issued in LA
Legal business name
PORT ALLEN CARE CENTER, LLC
Practice address
403 N 15TH St
Port Allen, LA 70767-2264
Phone
(225) 346-8815
Fax
(225) 346-8989
NPI assigned
Sep 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Victor D Gum
Title
Manager
Phone
(225) 800-4955

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 385 LA Primary

Addresses

Primary practice location

403 N 15TH St
Port Allen, LA 70767-2264

Mailing address

403 N 15TH St
Port Allen, LA 70767-2264
Phone (225) 346-8815

Other identifiers 1

IdentifierTypeStateIssuer
1520039MedicaidLA

Other names 1

  • Legacy Nursing and Rehabilitation of Port Allen Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040706001288 LA Part A Provider - Skilled Nursing Facility 9436136561 Practice locations: Port Allen, LA

Skilled nursing facility certification: CCN 195599

Legal name
PORT ALLEN CARE CENTER, LLC
Doing business as
LEGACY NURSING AND REHABILITATION OF PORT ALLEN
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jun 17, 2004
Last certification
Aug 14, 2024
Beds
125
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Nov 24, 1992 in LA
Enrollment address
403 North 15TH St
Port Allen, LA 70767-2264
Nursing home name
LEGACY NURSING AND REHABILITATION OF PORT ALLEN
Affiliated entity
LEGACY NURSING & REHABILITATION

Care Compare: Nursing home

Medicare Care Compare
Listed as
Legacy Nursing and Rehabilitation of Port AllenCCN 195599
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 17, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
125113.5 residents per day on average
Chain
Legacy Nursing & Rehabilitation9 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
2Fines totaling $140,868

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D0674756Legacy Nursing & Rehabilitation of Port Allen403 N 15TH Street, Port Allen, LA 70767Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Deidra Shavers Jones Individual W-2 Managing EmployeeAdministrator Oct 5, 2020 100%
Victor D Gum Individual 5% Or Greater Indirect Ownership Interest Jun 17, 2004 30%
W-2 Managing EmployeeManager Jun 17, 2004 100%
Gum Management, LLC Organization, Baton Rouge, LA LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Oct 27, 2021 100%
John Gum Individual 5% Or Greater Indirect Ownership Interest Jun 30, 2004 30%
Legacy Management Group, LLC Organization, Baton Rouge, LA LLC, For-profit 5% Or Greater Direct Ownership Interest Oct 27, 2021 100%
Operational/Managerial Control Oct 27, 2021 100%
Danielle G Prejean Individual 5% Or Greater Indirect Ownership Interest Jun 30, 2004 30%
John Nathaniel Gum Individual 5% Or Greater Indirect Ownership Interest Jun 30, 2004 10%
Port Allen Care Center, LLC Organization, Port Allen, LA Created for acquisition, LLC, Medical provider/supplier, For-profit 5% Or Greater Direct Ownership Interest Nov 24, 1992 100%

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556496000000",
    "number": "1063512903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 N 15TH ST",
            "city": "PORT ALLEN",
            "state": "LA",
            "postal_code": "707672264",
            "telephone_number": "225-346-8815",
            "fax_number": "225-346-8989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 N 15TH ST",
            "city": "PORT ALLEN",
            "state": "LA",
            "postal_code": "707672264",
            "telephone_number": "225-346-8815",
            "fax_number": "225-346-8989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT ALLEN CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2019-04-29",
        "status": "A",
        "authorized_official_last_name": "GUM",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "225-800-4955",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "LA",
            "license": "385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1520039",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Nursing and Rehabilitation of Port Allen",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Legacy Nursing and Rehabilitation of Port Allen",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Allen, LA

Sources for this page

Verify at the official NPI Registry.