Organization
COMMUNITY CARE CENTER OF SHREVEPORT SOUTH LLC
Active
Other names
Heritage Manor South
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TONI PARKINSON (AUTHORIZED REPRESENTATIVE)
(601) 709-1408
Entity
Organization
Contact information
Practice address
9712 MANSFIELD RD, SHREVEPORT, LA 71118-4406
(318) 687-2080
(318) 688-8103
Mailing address
9712 MANSFIELD RD, SHREVEPORT, LA 71118-4498
(318) 687-2080
(318) 688-8103
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
784
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1521434
—
LA
01
—
31054
BLUE CROSS BLUE SHIELD
LA
Enumeration date
05/04/2006
Last updated
11/30/2024
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