MEDICARE: SENIOR MANAGEMENT SERVICES OF SHREVEPORT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043209372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR MANAGEMENT SERVICES OF SHREVEPORT LLC

Provider Business Mailing Address
First Line	:	800 W ARBROOK BLVD
Second Line	:	STE 210
City	:	ARLINGTON
State	:	TX
Zip	:	76015-4327
Country	:	US
Telephone Number	:	817-468-1991
Fax Number	:	817-468-3133

Provider Business Practice Location Address
First Line	:	1736 IRVING PL
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4606
Country	:	US
Telephone Number	:	318-221-1983
Fax Number	:	318-222-2095

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TROY CLANTON
Credential	:
Telephone Number	:	817-468-1991

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	08/22/2020

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