Provider Demographics
NPI:1093796138
Name:LANDMARK NURSING CENTER OF WEST MONROE LLC
Entity Type:Organization
Organization Name:LANDMARK NURSING CENTER OF WEST MONROE LLC
Other - Org Name:LANDMARK NURSING & REHABILITATION CENTER OF WEST MONROE
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 1:1611 WELLERMAN RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7426
Mailing Address - Country:US
Mailing Address - Phone:318-396-3313
Mailing Address - Fax:318-396-3365
Practice Address - Street 1:1611 WELLERMAN RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7426
Practice Address - Country:US
Practice Address - Phone:318-396-3313
Practice Address - Fax:318-396-3365
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
LA689314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1520799Medicaid
LA1520799Medicaid