BOOKER SCC LLC (NPI# 1861873770) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861873770 |
| Entity Type | Organization |
| Organization Name | BOOKER SCC LLC |
| Other Organization Name | SCC OF BOOKER T. WASHINGTON REHABILITATION CENTER |
| Practice Address |
7605 Line Ave Shreveport LA 71106-5162 |
| Mailing Address |
600 N Pearl St Ste 1050 Dallas TX 75201-7495 |
| Practice Telephone | 3182192608 |
| Practice Fax Number | 3188617685 |
| Mailing Telephone | 2142527600 |
| Mailing Fax Number | 2142527704 |
| Enumeration Date | 2015-06-16 |
| 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 | MEDICARE PART A | 19-5615 | 01 |
| LA | 1510076 | 05 |
| Other Name | Type Code |
|---|---|
| SCC of Booker T. Washington Rehabilitation Center | Doing Business As Name - Organization |
| Street Address |
7605 LINE AVE |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71106-5162 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184185654 | Pmg Opco-washington LLC | Skilled Nursing Facility | 7605 Line Ave, Shreveport, LA 71106-5162 | 2019-03-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972008332 | Andrew Joseph Brouillette | Dentist | 385 Bert Kouns Industrial Loop Ste 700, Shreveport, LA 71106 | 2018-03-28 |
| 1548775885 | David Wayne Spears | Pharmacist | 10460 Norris Ferry Road, Shreveport, LA 71106 | 2017-12-08 |
| 1225559263 | Susan Anderson Roblow | Physical Therapist | 921 Unadilla Street, Shreveport, LA 71106 | 2017-06-29 |
| 1134656382 | James Lowder | Dentist | 8691 Line Ave Ste 300, Shreveport, LA 71106 | 2017-05-18 |
| 1144753708 | Laverne Brantley | Counselor | 328 E 69th St, Shreveport, LA 71106 | 2017-04-10 |
| 1437690849 | Biostat Laboratories, LLC | Clinical Medical Laboratory | 9742 Saint Vincent Ave Ste 200, Shreveport, LA 71106 | 2017-03-17 |
| 1841730728 | Cedric Thomas | Case Manager/Care Coordinator | 6811 Fairfield Avenue, Shreveport, LA 71106 | 2017-02-27 |
| 1225576192 | Nick Vergis | Pharmacist | 5828 Line Avenue, Shreveport, LA 71106 | 2017-02-10 |
| 1184162554 | Marilyn Johnson | Case Manager/Care Coordinator | 9245 Wallace Lake Rd Ste A, Shreveport, LA 71106 | 2017-02-06 |
| 1417499740 | Pamela Lee | Counselor | 8802 Coyth Ln, Shreveport, LA 71106 | 2016-11-17 |
| Find all providers in zip 71106 | ||||
| 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 |
|---|---|---|---|---|
| 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 |
| 1083662944 | Community Care Center of Shreveport South LLC | Skilled Nursing Facility | 9712 Mansfield Rd, Shreveport, LA 71118-4406 | 2006-05-04 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71106 |
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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.