Healthcare Provider Details

I. General information

NPI: 1780610683
Provider Name (Legal Business Name): MANSFIELD NURSING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 MCARTHUR DR
MANSFIELD LA
71052-4501
US

IV. Provider business mailing address

PO BOX 761
MANSFIELD LA
71052-0761
US

V. Phone/Fax

Practice location:
  • Phone: 318-872-9911
  • Fax: 318-871-4343
Mailing address:
  • Phone: 318-872-9911
  • Fax: 318-871-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number474
License Number StateLA

VIII. Authorized Official

Name: ROY BRIDGES
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-872-9911