Organization
VIRGINIA HALL NURSING HOME
Active
Other names
Progressive Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD EUGENE BOYTER N.F.A. (ADMINISTRATOR)
(318) 212-6461
Entity
Organization
Contact information
Practice address
2715 ALBERT L BICKNELL DR, SHREVEPORT, LA 71103-3925
(318) 212-8200
(318) 212-8220
Mailing address
2715 ALBERT L BICKNELL DR, SHREVEPORT, LA 71103-3925
(318) 212-8200
(318) 212-8220
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
284
LA
332BN1400X
Nursing Facility Supplies (DME)
—
LA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1516597
—
LA
Enumeration date
06/17/2006
Last updated
12/01/2008
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