# SENIORS CLUB

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

## Provider details

- **NPI number:** 1295951176
- **Authorized official:** MRS. KAREN R. MCCOY RN (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (318) 635-0010

## Contact information

- **Practice address:** 2653 MALCOLM ST, SHREVEPORT, LA 71108-2720
- **Practice address phone:** (318) 635-0010
- **Practice address fax:** (318) 635-8844
- **Mailing address:** 2653 MALCOLM ST, SHREVEPORT, LA 71108-2720
- **Mailing address phone:** (318) 635-0010
- **Mailing address fax:** (318) 635-8844

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 2677 | LA | Yes |

## Other

- **Enumeration date:** 04/18/2007
- **Last updated:** 06/23/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1560880 | — | LA |