Healthcare Provider Details

I. General information

NPI: 1043209372
Provider Name (Legal Business Name): SENIOR MANAGEMENT SERVICES OF SHREVEPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 IRVING PL
SHREVEPORT LA
71101-4606
US

IV. Provider business mailing address

800 W ARBROOK BLVD STE 210
ARLINGTON TX
76015-4327
US

V. Phone/Fax

Practice location:
  • Phone: 318-221-1983
  • Fax: 318-222-2095
Mailing address:
  • Phone: 817-468-1991
  • Fax: 817-468-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TROY CLANTON
Title or Position: PRESIDENT
Credential:
Phone: 817-468-1991