Provider Demographics
NPI:1346223708
Name:MANSFIELD NURSING CENTER, L.L.C.
Entity Type:Organization
Organization Name:MANSFIELD NURSING CENTER, L.L.C.
Other - Org Name:MANSFIELD NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-590-0007
Mailing Address - Street 1:PO BOX 761
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-0761
Mailing Address - Country:US
Mailing Address - Phone:318-872-9911
Mailing Address - Fax:318-872-9696
Practice Address - Street 1:1725 MCARTHUR DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-4501
Practice Address - Country:US
Practice Address - Phone:318-872-9911
Practice Address - Fax:318-872-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA474314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1518352Medicaid
LA195539Medicare Oscar/Certification
LA1518352Medicaid