# HERITAGE MANOR WEST LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Heritage Manor West
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770541922
- **Authorized official:** MRS. TONI PARKINSON (AUTHORIZED REPRESENTATIVE)
- **Authorized official phone:** 60170914708

## Contact information

- **Practice address:** 7060 COTTON WOOD ST, SHREVEPORT, LA 71129-2722
- **Practice address phone:** (318) 631-1846
- **Practice address fax:** (318) 636-2824
- **Mailing address:** 7060 COTTON WOOD ST, SHREVEPORT, LA 71129-2722
- **Mailing address phone:** (318) 631-1846
- **Mailing address fax:** (318) 636-2824

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 2203782206 | LA | Yes |
| 385H00000X | Respite Care | 2203782206 | LA | — |

## Other

- **Enumeration date:** 05/03/2006
- **Last updated:** 06/22/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1521493 | — | LA |
| 01 | — | 30406 | BLUE CROSS BLUE SHIELD | — |