# PRINCETON PLACE - RUSTON, LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Princeton Place - Ruston
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992746770
- **Authorized official:** DAWNE R SMITH (CEO)
- **Authorized official phone:** (318) 812-2140

## Contact information

- **Practice address:** 1405 WHITE ST, RUSTON, LA 71270-7213
- **Practice address phone:** (318) 812-2140
- **Practice address fax:** (318) 812-2143
- **Mailing address:** 1405 WHITE ST, RUSTON, LA 71270-7213
- **Mailing address phone:** (318) 812-2140
- **Mailing address fax:** (318) 812-2143

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 931 | LA | Yes |

## Other

- **Enumeration date:** 06/10/2006
- **Last updated:** 02/14/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1520233 | — | LA |
| 01 | — | 5887450001 | MEDICARE DMERC \# | TX |