Organization
COLONIAL LIVING CENTER, LLC
Active
Other names
Colonial Oaks Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID HARGRAVE (ADMINISTRATOR)
(504) 887-6414
Entity
Organization
Contact information
Practice address
4312 ITHACA ST, METAIRIE, LA 70006-2913
(504) 887-6414
(504) 887-5812
Mailing address
4312 ITHACA ST, METAIRIE, LA 70006-2913
(504) 887-6414
(504) 887-5812
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
779
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1521400
—
LA
01
—
4704660001
ENTERAL
LA
Enumeration date
07/05/2005
Last updated
02/16/2012
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