SHREVEPORT SCC LLC (NPI# 1609257450) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609257450 |
| Entity Type | Organization |
| Organization Name | SHREVEPORT SCC LLC |
| Other Organization Name | SCC OF SHREVEPORT MANOR REHABILITATION CENTER |
| Practice Address |
3302 Mansfield Rd Shreveport LA 71103-4106 |
| Mailing Address |
600 N Pearl St Ste 1050 Dallas TX 75201-7495 |
| Practice Telephone | 3182229482 |
| Practice Fax Number | 3184249985 |
| Mailing Telephone | 2142527600 |
| Mailing Fax Number | 2142527704 |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2020-03-04 |
| Authorized Official Name | MICHAEL BEAL (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 2142527600 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1517569 | 05 | |
| LA | MEDICARE PART A | 19-5515 | 01 |
| Other Name | Type Code |
|---|---|
| SCC of Shreveport Manor Rehabilitation Center | Doing Business As Name - Organization |
| Street Address |
3302 MANSFIELD RD |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71103-4106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417999780 | Shreveport Manor, LLC | Skilled Nursing Facility | 3302 Mansfield Rd, Shreveport, LA 71103-4106 | 2006-06-12 |
| 1942847454 | Tiffany Lefall | Nurse Practitioner | 3302 Mansfield Rd, Shreveport, LA 71103-4106 | 2019-12-03 |
| 1376004796 | Pmg Opco-shreveport LLC | Skilled Nursing Facility | 3302 Mansfield Rd, Shreveport, LA 71103-4106 | 2019-03-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083124887 | Elizabeth Ponder | Case Manager/Care Coordinator | 404 Hearne Avenue, Shreveport, LA 71103 | 2017-10-05 |
| 1245648393 | Madiha Tariq | General Acute Care Hospital | Rheumatology Clinic, 1501 Kings Hwy, Sheveport, LA 71103 | 2014-07-31 |
| 1659782688 | Jennifer G Smith | Pharmacist | 1725 Claiborne Ave, Shreveport, LA 71103 | 2014-05-13 |
| 1336568823 | Taylor Jieun Jung | Student in an Organized Health Care Education/Training Program | Lsu Health Sciences Center 1501 Kings Highway, Department of Oral & Maxillofacial Surgery Room 530, Shreveport, LA 71103 | 2014-04-10 |
| 1578984746 | Jamie Terrell | Pharmacist | 1625 Claiborne Ave, Shreveport, LA 71103 | 2013-12-13 |
| 1346675188 | Srijan Tandukar | Internal Medicine | 2751 Albert L Bicknell Dr Ste 2b, Shreveport, LA 71103 | 2013-09-12 |
| 1699017681 | Deanna Elise Mossallati | Internal Medicine | 8551 Greenwood Rd, Suite 410, Shreveport, LA 71103 | 2013-03-18 |
| 1346527330 | Tim M Smith | Clinical Exercise Physiologist | 3200 Greenwood Rd., Shreveport, LA 71103 | 2011-11-04 |
| 1144451683 | Second Chance Recovery | Durable Medical Equipment & Medical Supplies | 3816 Linwood, Shreveport, LA 71103 | 2009-07-31 |
| 1093919920 | Neeraj Singh | Internal Medicine | 2751 Albert L Bicknell Dr Fl 4, Shreveport, LA 71103 | 2007-06-13 |
| Find all providers in zip 71103 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861873770 | Booker Scc LLC | Skilled Nursing Facility | 7605 Line Ave, Shreveport, LA 71106-5162 | 2015-06-16 |
| 1073648853 | Booker T. Washington Guest Care Center, LLC | Skilled Nursing Facility | 7605 Line Ave., Shreveport, LA 71106-5162 | 2007-02-22 |
| 1275614497 | The Glen Retirement System | Skilled Nursing Facility | 1524 Glen Oak Pl, Shreveport, LA 71103-3816 | 2006-10-17 |
| 1417999780 | Shreveport Manor, LLC | Skilled Nursing Facility | 3302 Mansfield Rd, Shreveport, LA 71103-4106 | 2006-06-12 |
| 1609818046 | The Guest Care At Spring Lake, LLC | Skilled Nursing Facility | 8622 Line Ave, Shreveport, LA 71106-6108 | 2006-06-11 |
| 1073555652 | The Guest House LLC | Skilled Nursing Facility | 9225 Normandie Dr, Shreveport, LA 71118-3249 | 2006-06-11 |
| 1235179086 | Bradford Guest Care, LLC | Skilled Nursing Facility | 3050 Baird Rd, Shreveport, LA 71118-3818 | 2006-06-08 |
| 1619917432 | Multi-faith Retirement Services | Skilled Nursing Facility | 600 E Flournoy Lucas Rd, Shreveport, LA 71115-3855 | 2006-06-08 |
| 1508805037 | Heritage Manor Stratmore Nursing & Rehabilitation Center LLC | Skilled Nursing Facility | 530 Stratmore Dr, Shreveport, LA 71115-3020 | 2006-06-06 |
| 1144267451 | Willis Knighton Medical Center, Inc. | Skilled Nursing Facility | 2550 Kings Hwy, Shreveport, LA 71103-3922 | 2006-06-02 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71103 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.