Provider Demographics
NPI:1043209372
Name:SENIOR MANAGEMENT SERVICES OF SHREVEPORT LLC
Entity Type:Organization
Organization Name:SENIOR MANAGEMENT SERVICES OF SHREVEPORT LLC
Other - Org Name:NURSECARE NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-468-1991
Mailing Address - Street 1:800 W ARBROOK BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4327
Mailing Address - Country:US
Mailing Address - Phone:817-468-1991
Mailing Address - Fax:817-468-3133
Practice Address - Street 1:1736 IRVING PL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4606
Practice Address - Country:US
Practice Address - Phone:318-221-1983
Practice Address - Fax:318-222-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1522104Medicaid
LA1522104Medicaid