Provider Demographics
NPI:1184916520
Name:LADY OF THE OAKS RETIREMENT MANOR, LLC
Entity type:Organization
Organization Name:LADY OF THE OAKS RETIREMENT MANOR, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELATTE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:225-664-6697
Mailing Address - Street 1:301 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4722
Mailing Address - Country:US
Mailing Address - Phone:225-664-6697
Mailing Address - Fax:
Practice Address - Street 1:1005 ERASTE LANDRY RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3054
Practice Address - Country:US
Practice Address - Phone:337-232-6370
Practice Address - Fax:337-266-2071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA906314000000X
LA994314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2133748Medicaid
LA2133748Medicaid