Healthcare Provider Details

I. General information

NPI: 1174732333
Provider Name (Legal Business Name): LOUISIANA WAR VETERANS HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4739 HIGHWAY 10
JACKSON LA
70748
US

IV. Provider business mailing address

4739 HIGHWAY 10
JACKSON LA
70748
US

V. Phone/Fax

Practice location:
  • Phone: 225-634-5265
  • Fax: 225-634-4057
Mailing address:
  • Phone: 225-634-5265
  • Fax: 225-634-4057

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: MR. JON DAVID SALTER
Title or Position: ADMINISTRATOR
Credential: NFA
Phone: 225-634-5265