Healthcare Provider Details

I. General information

NPI: 1215921200
Provider Name (Legal Business Name): HOSPITAL SERVICE DISTRICT # 2 OF LASALLE PARISH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 9TH ST
JENA LA
71342-1510
US

IV. Provider business mailing address

PO DRAWER 1510 139 9TH ST
JENA LA
71342-1510
US

V. Phone/Fax

Practice location:
  • Phone: 318-992-6627
  • Fax: 318-992-9288
Mailing address:
  • Phone: 318-992-6627
  • Fax: 318-992-9288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number785
License Number StateLA

VIII. Authorized Official

Name: MR. WILLIAM JOHN NUNNALLY III
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-992-6627