Healthcare Provider Details

I. General information

NPI: 1467657304
Provider Name (Legal Business Name): NORTHEAST LOUISANA VETERANS HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 HIGHWAY 165 N
MONROE LA
71203-8753
US

IV. Provider business mailing address

6700 HIGHWAY 165 N
MONROE LA
71203-8753
US

V. Phone/Fax

Practice location:
  • Phone: 318-362-4206
  • Fax: 318-362-4241
Mailing address:
  • Phone: 318-362-4206
  • Fax: 318-362-4241

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: MRS. YOLANDA HOLMAN
Title or Position: ASSISTANT CFO
Credential: AO
Phone: 318-362-4206