Healthcare Provider Details

I. General information

NPI: 1952351140
Provider Name (Legal Business Name): LOUISIANA GUEST HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7414 SUMRALL DR
BATON ROUGE LA
70812-1240
US

IV. Provider business mailing address

PO BOX 8055
ALEXANDRIA LA
71306-1055
US

V. Phone/Fax

Practice location:
  • Phone: 225-356-0644
  • Fax: 225-357-5669
Mailing address:
  • Phone: 318-445-6470
  • Fax: 318-445-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number926
License Number StateLA

VIII. Authorized Official

Name: JAMES E RICHARDSON JR.
Title or Position: CEO
Credential:
Phone: 504-445-6470