Colonial Oaks Guest Care Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

872 Issued in LA

Legal business name

COLONIAL OAKS GUEST CARE CENTER, LLC

Practice address

4921 Medical Dr
Bossier City, LA 71112-4522

Phone

(318) 742-5420

Fax

(318) 742-8887

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": "1518909886",
    "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": "4921 MEDICAL DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711124522",
            "telephone_number": "318-742-5420",
            "fax_number": "318-742-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONIAL OAKS 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": "872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1510688",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Miranda Coleman
• Sara G Coleman, LMT #8705
• Dawn V Collins
• Cricket Collinsworth, M.S., CCC-SLP
• Monica N Collinsworth, CRNA
• Colonial SCC LLC (SCC of Colonial Oaks Rehabilitation Center)
• Courtney Elizabeth Colvin, M.C.D. CCC-SLP
• Jasmine Colvin
• Renae Fincher Colwick, MA, CCC-SLP
• Teresa Nakai Combs, CNA-CAREGIVER

• Skilled Nursing Facility in Bossier City, LA
• Providers in Bossier City, 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 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.