Organization
MARY GOSS NURSING HOME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDDYE LOUISE DAVIS (NURSING FACILITY ADMINISTRATOR)
(318) 323-9013
Entity
Organization
Contact information
Practice address
3300 WHITE ST, MONROE, LA 71203-5153
(318) 323-9013
(318) 324-1350
Mailing address
PO BOX 4509, MONROE, LA 71211-4509
(318) 323-9013
(318) 324-1350
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
41
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1510327
—
LA
Enumeration date
09/15/2005
Last updated
12/28/2009
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