# MARY GOSS NURSING HOME, INC

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

## Provider details

- **NPI number:** 1609861780
- **Authorized official:** EDDYE LOUISE DAVIS (NURSING FACILITY ADMINISTRATOR)
- **Authorized official phone:** (318) 323-9013

## Contact information

- **Practice address:** 3300 WHITE ST, MONROE, LA 71203-5153
- **Practice address phone:** (318) 323-9013
- **Practice address fax:** (318) 324-1350
- **Mailing address:** PO BOX 4509, MONROE, LA 71211-4509
- **Mailing address phone:** (318) 323-9013
- **Mailing address fax:** (318) 324-1350

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 41 | LA | Yes |

## Other

- **Enumeration date:** 09/15/2005
- **Last updated:** 12/28/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1510327 | — | LA |