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1417999780
SHREVEPORT MANOR, LLC
SHREVEPORT, LA
NPI
1417999780
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Entity Type
Organization
Authorized Contact
KEVIN C GAMBLE
Officer
318-798-2648
Organization Subpart ?
No
Primary Taxonomy
314000000X Skilled Nursing Facility
(Licence: LA 866)
Enumeration Date
2006-06-12
Last Update Date
2010-08-27
Business Address
SHREVEPORT MANOR, LLC
3302 MANSFIELD RD
SHREVEPORT, LA 71103-4106
Phone number: 318-222-9482
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Mailing Address
SHREVEPORT MANOR, LLC
PO BOX 52389
SHREVEPORT, LA 71135-2389
Phone number: 318-798-2648
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