Healthcare Provider Details

I. General information

NPI: 1114342953
Provider Name (Legal Business Name): LADY OF THE OAKS RETIREMENT MANOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 BACQUE CRESCENT DR
LAFAYETTE LA
70503-2842
US

IV. Provider business mailing address

301 VETERANS BLVD
DENHAM SPRINGS LA
70726-4722
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-0299
  • Fax: 225-667-2843
Mailing address:
  • Phone: 225-664-6697
  • Fax: 225-667-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number819
License Number StateLA

VIII. Authorized Official

Name: KIMBERLY W. DELATTE
Title or Position: COMPTROLLER
Credential: CPA
Phone: 225-664-6697