| Organization Name: | HERITAGE MANOR WEST LLC |
| NPI Number: | 1770541922 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TONI PARKINSON (AUTHORIZED REPRESENTATIVE) |
| Mailing Address: | 7060 Cotton Wood St Shreveport |
| State: | LA US |
| Postal Code: | 711292722 |
| Phone Number: | 3186311846 |
| Fax Number: | 3186362824 |
| NPI Enumeration Date: | 05/03/2006 |
| NPI Last Update Date: | 06/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | 2203782206 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | LA |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |