Organization
SENIORS CLUB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAREN R. MCCOY RN (EXECUTIVE DIRECTOR)
(318) 635-0010
Entity
Organization
Contact information
Practice address
2653 MALCOLM ST, SHREVEPORT, LA 71108-2720
(318) 635-0010
(318) 635-8844
Mailing address
2653 MALCOLM ST, SHREVEPORT, LA 71108-2720
(318) 635-0010
(318) 635-8844
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
7392
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1172596
—
LA
Enumeration date
04/18/2007
Last updated
06/23/2008
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