Clc of Lake Providence, LLC
NPI #1902896657 in Lake Providence, Louisiana
Provider Information
- NPI Number
- 1902896657
- Entity Type
- Organization
- Organization Name
- Clc of Lake Providence, LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Oct 25, 2005
- Last Updated
- Jan 28, 2008
Practice Location
- Address
- 5976 HIGHWAY 65 N
- City
- Lake Providence
- State
- Louisiana
- ZIP Code
- 71254-5235
- Phone
- (318) 559-4050
Authorized Official
- Name
- MR. DOUGLAS M. WRIGHT JR.
- Title
- MANAGING MEMBER
- Phone
- (662) 680-3148
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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