Organization
THE GLEN RETIREMENT SYSTEM
Active
Other names
Village Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBRA D. WILLIAMS (CHIEF FINANCIAL OFFICER)
(318) 798-3500
Entity
Organization
Contact information
Practice address
403 E FLOURNOY LUCAS RD, SHREVEPORT, LA 71115-3906
(318) 798-3500
(318) 798-7988
Mailing address
403 E FLOURNOY LUCAS RD, SHREVEPORT, LA 71115-3906
(318) 798-3500
(318) 798-7988
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
449
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1516864
—
LA
Enumeration date
10/17/2006
Last updated
08/22/2020
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