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General NPI Number Information
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NPI Number | 1609861780
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Entity Type | Organization
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Legal Business Name | MARY GOSS NURSING HOME, INC
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Dates
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Enumeration Date | 09/15/2005
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Last Update Date | 12/28/2009
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Provider Practice Location Address
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Address Line | 3300 WHITE ST
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City | MONROE
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State | LA
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Zip | 71203-5153
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Country | US
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Telephone | 318-323-9013
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Fax | 318-324-1350
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Provider Business Mailing Address
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Address Line | PO BOX 4509
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City | MONROE
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State | LA
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Zip | 71211-4509
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Country | US
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Telephone | 318-323-9013
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Fax | 318-324-1350
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Authorized Official
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Title or Position | NURSING FACILITY ADMINISTRATOR
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Name | EDDYE LOUISE DAVIS
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Credential |
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Telephone | 318-323-9013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 41
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License Number State | LA
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