Healthcare Provider Details

I. General information

NPI: 1972502185
Provider Name (Legal Business Name): OLLIE STEELE BURDEN MANOR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 BISHOP OTT DRIVE
BATON ROUGE LA
70806-8930
US

IV. Provider business mailing address

7435 BISHOP OTT DRIVE
BATON ROUGE LA
70806-8930
US

V. Phone/Fax

Practice location:
  • Phone: 225-216-3604
  • Fax: 225-216-3746
Mailing address:
  • Phone: 225-216-3604
  • Fax: 225-216-3746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number718
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD J. SMITH
Title or Position: PRESIDENT
Credential:
Phone: 225-216-3604