Provider Demographics
NPI:1780610683
Name:MANSFIELD NURSING CENTER
Entity type:Organization
Organization Name:MANSFIELD NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-872-9911
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:318-871-4343
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:318-871-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA474310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1518352Medicaid
LA195539Medicare ID - Type Unspecified