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Organization
TRI-STATE HEALTH SERVICES OF CENLA, LLC
Active
Organization
TRI-STATE HEALTH SERVICES OF CENLA, LLC
Active
Other names
HERITAGE NURSING CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOLLIE BORDEAUX (OWNER)
(318) 448-8778
Entity
Organization
Contact information
Practice address
1745 BAILEY AVE, HAYNESVILLE, LA 71038-5411
(318) 624-1166
(318) 624-0269
Mailing address
PO BOX 12486, ALEXANDRIA, LA 71315-2486
(318) 448-8778
(318) 448-8895
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
772
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1521183
—
LA
01
—
30377
BLUE CROSS
LA
Enumeration date
08/17/2005
Last updated
11/28/2007
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