Healthcare Provider Details

I. General information

NPI: 1093796138
Provider Name (Legal Business Name): LANDMARK NURSING CENTER OF WEST MONROE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 WELLERMAN RD
WEST MONROE LA
71291-7426
US

IV. Provider business mailing address

1611 WELLERMAN RD
WEST MONROE LA
71291-7426
US

V. Phone/Fax

Practice location:
  • Phone: 318-396-3313
  • Fax: 318-396-3365
Mailing address:
  • Phone: 318-396-3313
  • Fax: 318-396-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number689
License Number StateLA

VIII. Authorized Official

Name: MR. TEDDY RAY PRICE
Title or Position: MANAGING MEMBER
Credential:
Phone: 318-628-4116