Organization
COLONIAL OAKS GUEST CARE CENTER, 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
4921 MEDICAL DR, BOSSIER CITY, LA 71112-4522
(318) 742-5420
(318) 742-8887
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
872
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1510688
—
LA
Enumeration date
06/12/2006
Last updated
08/27/2010
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