# TRI-STATE HEALTH SERVICES OF CENLA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** HERITAGE NURSING CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689666489
- **Authorized official:** MR. TOLLIE BORDEAUX (OWNER)
- **Authorized official phone:** (318) 448-8778

## Contact information

- **Practice address:** 1745 BAILEY AVE, HAYNESVILLE, LA 71038-5411
- **Practice address phone:** (318) 624-1166
- **Practice address fax:** (318) 624-0269
- **Mailing address:** PO BOX 12486, ALEXANDRIA, LA 71315-2486
- **Mailing address phone:** (318) 448-8778
- **Mailing address fax:** (318) 448-8895

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 772 | LA | Yes |

## Other

- **Enumeration date:** 08/17/2005
- **Last updated:** 11/28/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1521183 | — | LA |
| 01 | — | 30377 | BLUE CROSS | LA |