Booker T. Washington Guest Care Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

993 Issued in LA

Legal business name

BOOKER T. WASHINGTON GUEST CARE CENTER, LLC

Practice address

7605 Line Ave.
Shreveport, LA 71106-5162

Phone

(318) 219-2608

Fax

(318) 861-7685

NPI assigned

Feb 22, 2007

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

President

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": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308700800000",
    "number": "1073648853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. 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": "7605 LINE AVE.",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711065162",
            "telephone_number": "318-219-2608",
            "fax_number": "318-861-7685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOOKER T. WASHINGTON GUEST CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2011-06-22",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "318-798-2648",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "LA",
            "license": "993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1510076",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Yvonne Booker
• Ashley Caroline Manning Boone

• Skilled Nursing Facility in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Skilled Nursing Facility in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2011; 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.