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Organization
COMMUNITY CARE CENTER OF SHREVEPORT SOUTH LLC
Active
Organization
COMMUNITY CARE CENTER OF SHREVEPORT SOUTH LLC
Active
Other names
Heritage Manor South
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TONI PARKINSON (AUTHORIZED REPRESENTATIVE)
(601) 709-1408
Entity
Organization
Contact information
Practice address
9712 MANSFIELD RD, SHREVEPORT, LA 71118-4406
(318) 687-2080
(318) 688-8103
Mailing address
9712 MANSFIELD RD, SHREVEPORT, LA 71118-4498
(318) 687-2080
(318) 688-8103
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
784
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1521434
—
LA
01
—
31054
BLUE CROSS BLUE SHIELD
LA
Enumeration date
05/04/2006
Last updated
11/30/2024
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