Organization
SHREVEPORT MANOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN C GAMBLE (OFFICER)
(318) 798-2648
Entity
Organization
Contact information
Practice address
3302 MANSFIELD RD, SHREVEPORT, LA 71103-4106
(318) 222-9482
(318) 424-9985
Mailing address
PO BOX 52389, SHREVEPORT, LA 71135-2389
(318) 798-2648
(318) 798-3451
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
866
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1517569
—
LA
Enumeration date
06/12/2006
Last updated
08/27/2010
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