MEDICARE: LOUISIANA GUEST HOUSE 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	926	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	:	1952351140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISIANA GUEST HOUSE LLC

Provider Business Mailing Address
First Line	:	PO BOX 8055
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71306-1055
Country	:	US
Telephone Number	:	318-445-6470
Fax Number	:	318-445-6422

Provider Business Practice Location Address
First Line	:	7414 SUMRALL DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70812-1240
Country	:	US
Telephone Number	:	225-356-0644
Fax Number	:	225-357-5669

Authorized Official
Title or Position	:	CEO
Name	:	JAMES E RICHARDSON JR.
Credential	:
Telephone Number	:	504-445-6470

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	08/22/2020

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