Provider Demographics
NPI:1306390588
Name:QUALITY LONG TERM CARE LLC
Entity Type:Organization
Organization Name:QUALITY LONG TERM CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-281-4925
Mailing Address - Street 1:300 W WALNUT AVE.
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220
Mailing Address - Country:US
Mailing Address - Phone:318-281-4925
Mailing Address - Fax:318-281-4927
Practice Address - Street 1:300 W WALNUT AVE.
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220
Practice Address - Country:US
Practice Address - Phone:318-281-4925
Practice Address - Fax:318-281-4927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAHC00081213747A0650X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAHC0008121Medicaid