# SHANNONDALE OF ALEXANDRIA, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** REGENCY HOUSE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083722193
- **Authorized official:** MICHAEL R. HATHORN (NFA)
- **Authorized official phone:** (318) 445-8343

## Contact information

- **Practice address:** 5131 MASONIC DR, ALEXANDRIA, LA 71301-3366
- **Practice address phone:** (318) 445-8343
- **Practice address fax:** (318) 445-8527
- **Mailing address:** 5131 MASONIC DR, ALEXANDRIA, LA 71301-3366
- **Mailing address phone:** (318) 445-8343
- **Mailing address fax:** (318) 445-8527

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 456 | LA | Yes |

## Other

- **Enumeration date:** 08/28/2006
- **Last updated:** 12/02/2008