Provider Demographics
NPI:1033140926
Name:MER ROUGE COMMUNITY SVC INC
Entity Type:Organization
Organization Name:MER ROUGE COMMUNITY SVC INC
Other - Org Name:THE OAKWOODS HOME FOR THE ELDERLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:NFA
Authorized Official - Phone:318-647-3691
Mailing Address - Street 1:1400 DAVENPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MER ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:71261
Mailing Address - Country:US
Mailing Address - Phone:318-647-3691
Mailing Address - Fax:318-647-3743
Practice Address - Street 1:1400 DAVENPORT AVE
Practice Address - Street 2:
Practice Address - City:MER ROUGE
Practice Address - State:LA
Practice Address - Zip Code:71261
Practice Address - Country:US
Practice Address - Phone:318-647-3691
Practice Address - Fax:318-647-3743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA227364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1512273Medicaid
195598Medicare ID - Type Unspecified