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Organization
HERITAGE MANOR WEST LLC
Active
Organization
HERITAGE MANOR WEST LLC
Active
Other names
Heritage Manor West
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TONI PARKINSON (AUTHORIZED REPRESENTATIVE)
60170914708
Entity
Organization
Contact information
Practice address
7060 COTTON WOOD ST, SHREVEPORT, LA 71129-2722
(318) 631-1846
(318) 636-2824
Mailing address
7060 COTTON WOOD ST, SHREVEPORT, LA 71129-2722
(318) 631-1846
(318) 636-2824
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2203782206
LA
385H00000X
Respite Care
2203782206
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1521493
—
LA
01
—
30406
BLUE CROSS BLUE SHIELD
—
Enumeration date
05/03/2006
Last updated
06/22/2015
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