# KENTWOOD MANOR NURSING HOME, L.L.C.

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

## Provider details

- **NPI number:** 1720038961
- **Authorized official:** JAMES E. RICHARDSON JR. (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (318) 445-6470

## Contact information

- **Practice address:** 921 AVENUE G, KENTWOOD, LA 70444-2636
- **Practice address phone:** (985) 229-2112
- **Practice address fax:** (985) 229-6922
- **Mailing address:** PO BOX 8055, ALEXANDRIA, LA 71306-1055
- **Mailing address phone:** (318) 445-6470
- **Mailing address fax:** (318) 445-6422

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 927 | LA | Yes |

## Other

- **Enumeration date:** 05/10/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1515027 | — | LA |