Organization
KENTWOOD MANOR NURSING HOME, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES E. RICHARDSON JR. (CHIEF EXECUTIVE OFFICER)
(318) 445-6470
Entity
Organization
Contact information
Practice address
921 AVENUE G, KENTWOOD, LA 70444-2636
(985) 229-2112
(985) 229-6922
Mailing address
PO BOX 8055, ALEXANDRIA, LA 71306-1055
(318) 445-6470
(318) 445-6422
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
927
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1515027
—
LA
Enumeration date
05/10/2006
Last updated
08/22/2020
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