# COLONIAL LIVING CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Colonial Oaks Living Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720085723
- **Authorized official:** MR. DAVID HARGRAVE (ADMINISTRATOR)
- **Authorized official phone:** (504) 887-6414

## Contact information

- **Practice address:** 4312 ITHACA ST, METAIRIE, LA 70006-2913
- **Practice address phone:** (504) 887-6414
- **Practice address fax:** (504) 887-5812
- **Mailing address:** 4312 ITHACA ST, METAIRIE, LA 70006-2913
- **Mailing address phone:** (504) 887-6414
- **Mailing address fax:** (504) 887-5812

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 779 | LA | Yes |

## Other

- **Enumeration date:** 07/05/2005
- **Last updated:** 02/16/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1521400 | — | LA |
| 01 | — | 4704660001 | ENTERAL | LA |