Provider Demographics
NPI:1770635211
Name:SOUTHEAST LOUISIANA VETERANS HOME
Entity Type:Organization
Organization Name:SOUTHEAST LOUISIANA VETERANS HOME
Other - Org Name:SOUTHEAST LOUISIANA WAR VETERANS HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LTC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEVELAND
Authorized Official - Middle Name:J
Authorized Official - Last Name:OBEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:985-479-4080
Mailing Address - Street 1:4080 W AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:RESERVE
Mailing Address - State:LA
Mailing Address - Zip Code:70084-5712
Mailing Address - Country:US
Mailing Address - Phone:985-479-4080
Mailing Address - Fax:985-479-4090
Practice Address - Street 1:4080 W AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:LA
Practice Address - Zip Code:70084-5712
Practice Address - Country:US
Practice Address - Phone:985-479-4080
Practice Address - Fax:985-479-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA282E00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No282E00000XHospitalsLong Term Care Hospital