MEDICARE: OLLIE STEELE BURDEN MANOR, INC

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	332BN1400X	Nursing Facility Supplies (DME)
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	314000000X	Skilled Nursing Facility
4	314000000X	Skilled Nursing Facility	718	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	:	1972502185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLLIE STEELE BURDEN MANOR, INC

Provider Business Mailing Address
First Line	:	7435 BISHOP OTT DRIVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-8930
Country	:	US
Telephone Number	:	225-216-3604
Fax Number	:	225-216-3746

Provider Business Practice Location Address
First Line	:	7435 BISHOP OTT DRIVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-8930
Country	:	US
Telephone Number	:	225-216-3604
Fax Number	:	225-216-3746

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EDWARD J. SMITH
Credential	:
Telephone Number	:	225-216-3604

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	04/21/2009

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