Organization
QUALITY LONG TERM CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRESTON THOMAS GOODSON (ASSISTANT ADMINISTRATOR)
(318) 281-4925
Entity
Organization
Contact information
Practice address
300 W WALNUT AVE., BASTROP, LA 71220
(318) 281-4925
(318) 281-4927
Mailing address
300 W WALNUT AVE., BASTROP, LA 71220
(318) 281-4925
(318) 281-4927
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
HC0008121
LA
3747P1801X
Personal Care Attendant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HC0008121
—
LA
Enumeration date
08/05/2016
Last updated
04/01/2022
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