Healthcare Provider Details

I. General information

NPI: 1659380004
Provider Name (Legal Business Name): SOUTHERN ACRES CARE CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 REDDIX LN
MONROE LA
71202-5949
US

IV. Provider business mailing address

4600 REDDIX LN
MONROE LA
71202-5949
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-3100
  • Fax: 318-323-7482
Mailing address:
  • Phone: 318-322-3100
  • Fax: 318-323-7482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number853
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateLA

VIII. Authorized Official

Name: MS. DAWNE R SMITH
Title or Position: CEO
Credential:
Phone: 318-812-2140