NPIMap

Organization Active NPI

Southern Oaks Nursing & Rehabilitation Center, LLC

  • Skilled Nursing Facility
  • Shreveport, LA
National Provider Identifier
1124186937
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
93 Issued in LA
Legal business name
SOUTHERN OAKS NURSING & REHABILITATION CENTER, LLC
Practice address
1524 Glen Oak PL
Shreveport, LA 71103-3816
Phone
(318) 221-0911
Fax
(318) 222-6333
NPI assigned
Dec 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

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

Authorized official

Name
Teddy Ray Price
Title
Managing Member
Phone
(318) 628-4116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 93 LA Primary

Addresses

Primary practice location

1524 Glen Oak PL
Shreveport, LA 71103-3816

Mailing address

1524 Glen Oak PL
Shreveport, LA 71103-3816
Phone (318) 221-0911

Other identifiers 1

IdentifierTypeStateIssuer
1510394MedicaidLA

Other names 1

  • SOUTHERN OAKS NURSING & REHABILITATION CENTER Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler Other CMS HIH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070112000539 LA Part A Provider - Skilled Nursing Facility 1759381890 Practice locations: Shreveport, LA

Skilled nursing facility certification: CCN 195558

Legal name
SOUTHERN OAKS NURSING & REHABILITATION CENTER, LLC
Doing business as
SOUTHERN OAKS NURSING & REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 24, 2002
Last certification
May 21, 2025
Beds
61
Ownership / control type
Corporation
Multi-facility organization
Central Management Company
Most recent change of ownership
Dec 1, 2006
Organization structure
LLCProprietary
Enrollment address
1524 Glen Oak PL
Shreveport, LA 71103-3816
Nursing home name
SOUTHERN OAKS NURSING & REHABILITATION CENTER
Affiliated entity
CENTRAL MANAGEMENT COMPANY

Care Compare: Nursing home

Medicare Care Compare
Listed as
Southern Oaks Nursing & Rehabilitation CenterCCN 195558
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Oct 24, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6155.0 residents per day on average
Chain
Central Management Company21 facilities in the chain
Penalties (3 years)
2Fines totaling $116,623

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Individual Adp of the SNF Mar 18, 2025
Organization, Winnfield, LA LLC, Holding company Adp of the SNF Dec 1, 2006
Teddy D Price Individual Operational/Managerial Control Mar 1, 2025
Adp of the SNF Mar 1, 2025
Jeffrey Lee Cantrell Individual Adp of the SNF Oct 1, 2013
Teddy R Price Individual 5% Or Greater Indirect Ownership Interest Dec 1, 2006 100%
Operational/Managerial ControlManaging Member/Ceo Dec 1, 2006 100%
Adp of the SNF Dec 1, 2006
Indirect Ownership Interest Dec 1, 2006 100%
Central Management Company, LLC Organization, Winnfield, LA LLC, Management services company, Chain home office Operational/Managerial Control Dec 1, 2006 100%
Adp of the SNF Apr 2, 2025
Dawn Rogers Individual Adp of the SNF Dec 1, 2006
Sheila M Bolwahnn Individual Adp of the SNF Dec 1, 2006
James Shelton Individual Adp of the SNF Dec 1, 2006
Individual Adp of the SNF Dec 1, 2006
Individual Adp of the SNF Dec 1, 2006
Organization, Lake Charles, LA LLC Adp of the SNF Apr 2, 2025
Kisatchie Health, LLC Organization, Winnfield, LA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Dec 1, 2006 100%
Adp of the SNF Dec 1, 2006
Individual Adp of the SNF Jan 1, 2010
Individual Adp of the SNF Mar 18, 2025
Organization, Lake Charles, LA LLC, Consulting firm Adp of the SNF Apr 2, 2025
Individual Adp of the SNF Jan 1, 2011
Individual Adp of the SNF Mar 18, 2025
Organization, Winnfield, LA LLC, Consulting firm Adp of the SNF Apr 2, 2025

Facilities with the same owner 23

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 23

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1124186937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1524 GLEN OAK PL",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033816",
            "telephone_number": "318-221-0911",
            "fax_number": "318-222-6333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1524 GLEN OAK PL",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033816",
            "telephone_number": "318-221-0911",
            "fax_number": "318-222-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OAKS NURSING & REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "TEDDY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "318-628-4116"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "LA",
            "license": "93",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1510394",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "CMS HIH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CMS esMD eMR",
            "address_1": "7500 Security Blvd",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212441849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "SOUTHERN OAKS NURSING & REHABILITATION CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SOUTHERN OAKS NURSING & REHABILITATION CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.