Healthcare Provider Details

I. General information

NPI: 1376542969
Provider Name (Legal Business Name): WOODLAND VILLAGE 5301 TENANT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 TULLIS DR
NEW ORLEANS LA
70131-8805
US

IV. Provider business mailing address

5301 TULLIS DR
NEW ORLEANS LA
70131-8805
US

V. Phone/Fax

Practice location:
  • Phone: 504-394-5807
  • Fax: 504-394-5980
Mailing address:
  • Phone: 504-394-5807
  • Fax: 504-394-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number791
License Number StateLA

VIII. Authorized Official

Name: MR. ALEX PALEY
Title or Position: COO
Credential:
Phone: 914-390-4363