Provider Demographics
NPI:1205823358
Name:LANE MEMORIAL HOSPITAL SKILLED NURSING FACILITY
Entity Type:Organization
Organization Name:LANE MEMORIAL HOSPITAL SKILLED NURSING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:225-658-4000
Mailing Address - Street 1:6300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4037
Mailing Address - Country:US
Mailing Address - Phone:225-658-4000
Mailing Address - Fax:225-658-4289
Practice Address - Street 1:6300 MAIN ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4037
Practice Address - Country:US
Practice Address - Phone:225-658-4000
Practice Address - Fax:225-658-4289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2022-07-21
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
LA195276Medicare ID - Type UnspecifiedFEDERAL NO.