Healthcare Provider Details

I. General information

NPI: 1144463407
Provider Name (Legal Business Name): NORTHRIDGE CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3612 BAKER BLVD
BAKER LA
70714-2513
US

IV. Provider business mailing address

PO BOX 8055
ALEXANDRIA LA
71306-1055
US

V. Phone/Fax

Practice location:
  • Phone: 225-778-0573
  • Fax:
Mailing address:
  • Phone: 318-445-6470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. NICOLE HOWARD
Title or Position: C.F.O.
Credential:
Phone: 318-445-6470