Healthcare Provider Details

I. General information

NPI: 1780452102
Provider Name (Legal Business Name): OAK HAVEN SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HIGHWAY 107
CENTER PORT LA
71323
US

IV. Provider business mailing address

1515 HIGHWAY 107
CENTER POINT LA
71323-3529
US

V. Phone/Fax

Practice location:
  • Phone: 318-253-4601
  • Fax: 318-253-4668
Mailing address:
  • Phone: 318-253-4601
  • Fax: 318-253-4668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MENUCHA GOODMAN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 848-201-8402