Provider Demographics
NPI:1003897158
Name:RESTHAVEN NURSING CENTER PARTNERSHIP
Entity Type:Organization
Organization Name:RESTHAVEN NURSING CENTER PARTNERSHIP
Other - Org Name:RESTHAVEN NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TEDDY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-628-4116
Mailing Address - Street 1:1103 W MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5431
Mailing Address - Country:US
Mailing Address - Phone:337-477-6300
Mailing Address - Fax:337-477-7189
Practice Address - Street 1:1103 W MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5431
Practice Address - Country:US
Practice Address - Phone:337-477-6300
Practice Address - Fax:337-477-7189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA149314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1517194Medicaid
LA195414Medicare Oscar/Certification
LA195414Medicare ID - Type Unspecified