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Organization
NORMANDIE SCC LLC
Active
Organization
NORMANDIE SCC LLC
Active
Other names
The Guest House Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICCAHEL BEAL (CHIEF EXECUTIVE OFFICER)
(214) 252-7600
Entity
Organization
Contact information
Practice address
9225 NORMANDIE DR, SHREVEPORT, LA 71118-3249
(318) 686-0515
(318) 687-0311
Mailing address
600 N PEARL ST STE 1050, DALLAS, TX 75201-7495
(214) 252-7600
(214) 252-7704
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518221
—
LA
01
—
19-5380
MEDICARE PART A
LA
Enumeration date
06/16/2015
Last updated
03/04/2020
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