Provider Demographics
NPI:1902855372
Name:LOUISIANA GUEST HOUSE LLC
Entity Type:Organization
Organization Name:LOUISIANA GUEST HOUSE LLC
Other - Org Name:MAGNOLIA ESTATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-445-6470
Mailing Address - Street 1:PO BOX 8055
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306-1055
Mailing Address - Country:US
Mailing Address - Phone:318-445-6470
Mailing Address - Fax:318-445-6422
Practice Address - Street 1:1511 DULLES DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3718
Practice Address - Country:US
Practice Address - Phone:337-216-0950
Practice Address - Fax:337-216-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA923314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1521477Medicaid
195573Medicare ID - Type Unspecified