Organization
BOOKER T. WASHINGTON GUEST CARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN C. GAMBLE (PRESIDENT)
(318) 798-2648
Entity
Organization
Contact information
Practice address
7605 LINE AVE., SHREVEPORT, LA 71106-5162
(318) 219-2608
(318) 861-7685
Mailing address
P.O. BOX 52389, SHREVEPORT, LA 71135-2389
(318) 798-2648
(318) 798-3451
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
993
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1510076
—
LA
Enumeration date
02/22/2007
Last updated
06/22/2011
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