NPIMap

Organization Active NPI

Shannondale of Alexandria, Inc.

  • Nursing Facility/Intermediate Care Facility
  • Alexandria, LA
National Provider Identifier
1083722193
Registry record updated Dec 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
456 Issued in LA
Legal business name
SHANNONDALE OF ALEXANDRIA, INC.
Doing business as
REGENCY HOUSE
Practice address
5131 Masonic Dr
Alexandria, LA 71301-3366
Phone
(318) 445-8343
Fax
(318) 445-8527
NPI assigned
Aug 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2008

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

Authorized official

Name
Michael R. Hathorn
Title
Nfa
Phone
(318) 445-8343

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 456 LA Primary

Addresses

Primary practice location

5131 Masonic Dr
Alexandria, LA 71301-3366

Mailing address

5131 Masonic Dr
Alexandria, LA 71301-3366
Phone (318) 445-8343

Other names 1

  • REGENCY HOUSE Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228176000000",
    "number": "1083722193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5131 MASONIC DR",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713013366",
            "telephone_number": "318-445-8343",
            "fax_number": "318-445-8527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5131 MASONIC DR",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713013366",
            "telephone_number": "318-445-8343",
            "fax_number": "318-445-8527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANNONDALE OF ALEXANDRIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2008-12-02",
        "status": "A",
        "authorized_official_last_name": "HATHORN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "NFA",
        "authorized_official_telephone_number": "318-445-8343"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "LA",
            "license": "456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "REGENCY HOUSE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alexandria, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2008; 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.