Provider Demographics
NPI:1902955636
Name:NW LA WAR VETERANS HOME
Entity Type:Organization
Organization Name:NW LA WAR VETERANS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-741-2763
Mailing Address - Street 1:3130 ARTHUR RAY TEAGUE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112
Mailing Address - Country:US
Mailing Address - Phone:318-741-2763
Mailing Address - Fax:
Practice Address - Street 1:3130 ARTHUR RAY TEAGUE PARKWAY
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112
Practice Address - Country:US
Practice Address - Phone:318-741-2763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISIANA DEPARTMENT OF VETERANS AFFAIRS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-10
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility