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General NPI Number Information
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NPI Number | 1659380004
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Entity Type | Organization
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Legal Business Name | SOUTHERN ACRES CARE CENTER, LP
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 02/14/2014
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Provider Practice Location Address
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Address Line | 4600 REDDIX LN
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City | MONROE
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State | LA
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Zip | 71202-5949
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Country | US
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Telephone | 318-322-3100
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Fax | 318-323-7482
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Provider Business Mailing Address
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Address Line | 4600 REDDIX LN
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City | MONROE
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State | LA
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Zip | 71202-5949
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Country | US
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Telephone | 318-322-3100
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Fax | 318-323-7482
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Authorized Official
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Title or Position | CEO
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Name | MS. DAWNE R SMITH
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Credential |
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Telephone | 318-812-2140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 853
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License Number State | LA
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