Healthcare Provider Details

I. General information

NPI: 1386648848
Provider Name (Legal Business Name): SHERWOOD 2828 TENANT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 WESTFORK DR
BATON ROUGE LA
70816-2290
US

IV. Provider business mailing address

2828 WESTFORK DR
BATON ROUGE LA
70816-2290
US

V. Phone/Fax

Practice location:
  • Phone: 225-291-7049
  • Fax: 225-906-9321
Mailing address:
  • Phone: 225-291-7049
  • Fax: 225-906-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number793
License Number StateLA

VIII. Authorized Official

Name: MR. ALEX PALEY
Title or Position: COO
Credential:
Phone: 914-390-4363