Provider Demographics
NPI:1891794095
Name:OLLIE STEELE BURDEN MANOR INC
Entity Type:Organization
Organization Name:OLLIE STEELE BURDEN MANOR INC
Other - Org Name:OLLIE STEELE BURDEN MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FOLSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-926-0091
Mailing Address - Street 1:4250 ESSEN LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2158
Mailing Address - Country:US
Mailing Address - Phone:225-926-0091
Mailing Address - Fax:225-926-4937
Practice Address - Street 1:4250 ESSEN LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2158
Practice Address - Country:US
Practice Address - Phone:225-926-0091
Practice Address - Fax:225-926-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA246314000000X, 332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA195566Medicare ID - Type Unspecified
LA1099010001Medicare NSC