# MARTIN DE PORRES NURSING HOME, INC

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

## Provider details

- **NPI number:** 1538159033
- **Authorized official:** BILL BREWER (ASSISTANT EXECUTIVE DIRECTOR)
- **Authorized official phone:** (337) 439-5761

## Contact information

- **Practice address:** 200 TEAL ST, LAKE CHARLES, LA 70615-6841
- **Practice address phone:** (337) 439-5761
- **Practice address fax:** (337) 466-4788
- **Mailing address:** 200 TEAL ST, LAKE CHARLES, LA 70615-6841
- **Mailing address phone:** (337) 439-5761
- **Mailing address fax:** (337) 433-4788

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 231 | LA | Yes |

## Other

- **Enumeration date:** 10/26/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1512303 | — | LA |