Community Care Center Of Shreveport South LLC
Skilled Nursing Facility in Shreveport, LA. Organization (NPI-2).
NPI number1083662944
StatusActive
Last updated in NPPESNov 30, 2024
Details
- NPI
- 1083662944
- Entity type
- Organization (NPI-2)
- Legal business name
- Community Care Center Of Shreveport South LLC
- Organization subpart
- No
- Enumeration date
- May 4, 2006
- Certification date
- Nov 30, 2024
- Last updated
- Nov 30, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 314000000X | Skilled Nursing Facility | 784 | LA | Yes |
Other names
- Heritage Manor South (Doing Business As)
Practice location
9712 Mansfield RdShreveport, LA 71118-4406
Phone 318-687-2080 · Fax 318-688-8103
Mailing address
9712 Mansfield RdShreveport, LA 71118-4498
Phone 318-687-2080 · Fax 318-688-8103
Authorized official
Toni Parkinson
Authorized Representative
6017091408
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