Organization
SHREVEPORT SCC LLC
Active
Other names
SCC of Shreveport Manor Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BEAL (CHIEF EXECUTIVE OFFICER)
(214) 252-7600
Entity
Organization
Contact information
Practice address
3302 MANSFIELD RD, SHREVEPORT, LA 71103-4106
(318) 222-9482
(318) 424-9985
Mailing address
600 N PEARL ST STE 1050, DALLAS, TX 75201-7495
(214) 252-7600
(214) 252-7704
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1517569
—
LA
01
—
19-5515
MEDICARE PART A
LA
Enumeration date
06/17/2015
Last updated
03/04/2020
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