Healthcare Provider Details

I. General information

NPI: 1306390588
Provider Name (Legal Business Name): QUALITY LONG TERM CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W WALNUT AVE.
BASTROP LA
71220
US

IV. Provider business mailing address

300 W WALNUT AVE.
BASTROP LA
71220
US

V. Phone/Fax

Practice location:
  • Phone: 318-281-4925
  • Fax: 318-281-4927
Mailing address:
  • Phone: 318-281-4925
  • Fax: 318-281-4927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberHC0008121
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: PRESTON THOMAS GOODSON
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 318-281-4925