# BOOKER T. WASHINGTON GUEST CARE CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073648853
- **Authorized official:** MR. KEVIN C. GAMBLE (PRESIDENT)
- **Authorized official phone:** (318) 798-2648

## Contact information

- **Practice address:** 7605 LINE AVE., SHREVEPORT, LA 71106-5162
- **Practice address phone:** (318) 219-2608
- **Practice address fax:** (318) 861-7685
- **Mailing address:** P.O. BOX 52389, SHREVEPORT, LA 71135-2389
- **Mailing address phone:** (318) 798-2648
- **Mailing address fax:** (318) 798-3451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 993 | LA | Yes |

## Other

- **Enumeration date:** 02/22/2007
- **Last updated:** 06/22/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1510076 | — | LA |