Organization
MARTIN DE PORRES NURSING HOME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BILL BREWER (ASSISTANT EXECUTIVE DIRECTOR)
(337) 439-5761
Entity
Organization
Contact information
Practice address
200 TEAL ST, LAKE CHARLES, LA 70615-6841
(337) 439-5761
(337) 466-4788
Mailing address
200 TEAL ST, LAKE CHARLES, LA 70615-6841
(337) 439-5761
(337) 433-4788
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
231
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1512303
—
LA
Enumeration date
10/26/2005
Last updated
08/22/2020
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