Healthcare Provider Details

I. General information

NPI: 1912931254
Provider Name (Legal Business Name): WOODLAWN MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MCKEEN PL
MONROE LA
71201
US

IV. Provider business mailing address

PO BOX 3068
MONROE LA
71210-3068
US

V. Phone/Fax

Practice location:
  • Phone: 318-361-9555
  • Fax: 318-361-0740
Mailing address:
  • Phone: 318-361-9555
  • Fax: 318-361-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number388
License Number StateLA

VIII. Authorized Official

Name: REBECCA H ROUNSAVILLE
Title or Position: ACCOUNTANT
Credential:
Phone: 318-361-9555