Healthcare Provider Details

I. General information

NPI: 1356391510
Provider Name (Legal Business Name): LOUISIANA GUEST HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S LOUISE ST
JENNINGS LA
70546-6203
US

IV. Provider business mailing address

PO BOX 8055
ALEXANDRIA LA
71306-1055
US

V. Phone/Fax

Practice location:
  • Phone: 337-824-2466
  • Fax: 337-824-2465
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 Number924
License Number StateLA

VIII. Authorized Official

Name: JAMES E RICHARDSON JR.
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 318-445-6470