Pilgrim Manor Guest Care Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

873 Issued in LA

Legal business name

PILGRIM MANOR GUEST CARE CENTER, LLC

Practice address

1524 Doctors Dr
Bossier City, LA 71111-3322

Phone

(318) 742-1623

Fax

(318) 742-2878

NPI assigned

Jun 12, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kevin C Gamble

Title

Officer

Phone

(318) 798-2648

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282867200000",
    "number": "1063454338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 52389",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711352389",
            "telephone_number": "318-798-2648",
            "fax_number": "318-798-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1524 DOCTORS DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711113322",
            "telephone_number": "318-742-1623",
            "fax_number": "318-742-2878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PILGRIM MANOR GUEST CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2010-08-27",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "318-798-2648",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "LA",
            "license": "873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1510696",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Bossier City, LA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.