MEDICARE: FLANNERY OAKS GH BR, 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

General Provider Information

NPI Number	:	1194501999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLANNERY OAKS GH BR, LLC

Provider Business Mailing Address
First Line	:	301 VETERANS BLVD
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4722
Country	:	US
Telephone Number	:	225-664-6697
Fax Number	:

Provider Business Practice Location Address
First Line	:	1642 N FLANNERY RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-2827
Country	:	US
Telephone Number	:	225-275-6393
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	KIMBERLY W DELATTE
Credential	:
Telephone Number	:	225-664-6697

Provider Enumeration Date	:	09/06/2023
Last Update Date	:	04/07/2026

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