SHREVEPORT MANOR, LLC
NPI 1417999780
Skilled Nursing Facility in Shreveport, LA

Active since June 12, 2006CLIA 19D0672744 · Waiver
3302 MANSFIELD RD, SHREVEPORT, LA 71103(318) 222-9482(318) 424-9985 Get Directions Write a Review

NPPES record last updated: August 27, 2010. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Shreveport Manor, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHREVEPORT MANOR, LLC (NPI 1417999780) is a healthcare organization registered as a skilled nursing facility in Shreveport, Louisiana and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Kevin C Gamble, Officer, as its authorized official.

NPPES Registry Identity

NPI1417999780
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameSHREVEPORT MANOR, LLC
Location Address3302 MANSFIELD RDShreveport, LA 71103-4106
Mailing AddressPo Box 52389Shreveport, LA 71135-2389 · (318) 798-2648 · Fax (318) 798-3451
Fax(318) 424-9985
Organization SubpartNo
Authorized OfficialKevin C GambleOfficer · (318) 798-2648
Enumeration DateJune 12, 2006
Last NPPES UpdateAugust 27, 2010
NPI 1417999780 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in LA · 866
Definition
(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.
3302 MANSFIELD RD, Shreveport, LA 71103

Other Identifiers 2

Medicaid1517569LA
Medicare ID-Type Unspecified195515LA · Provider Number

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 19D0672744

Shreveport Manor Skilled Nursing & Rehabilitation · Shreveport, LA
Active · expires Aug 31, 2026
CLIA Number19D0672744
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorJohn T. Mauldin
Laboratory Phone(318) 222-9482
Laboratory LocationShreveport Manor Skilled Nursing & Rehabilitation3302 Mansfield Rd, Shreveport, LA 71103
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Skilled Nursing Facility
3302 MANSFIELD RD
SHREVEPORT, LA 71103
Skilled Nursing Facility
3302 MANSFIELD RD
SHREVEPORT, LA 71103
Nurse Practitioner (Family)
3302 MANSFIELD RD
SHREVEPORT, LA 71103

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shreveport Manor, LLC's NPI number?

The NPI number for Shreveport Manor, LLC is 1417999780. It was assigned to this organization in the NPPES registry on June 12, 2006.

Where is Shreveport Manor, LLC located?

Shreveport Manor, LLC is located at 3302 Mansfield Rd, Shreveport, LA 71103. The listed phone number is (318) 222-9482.

What is Shreveport Manor, LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Shreveport Manor, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 19D0672744) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Shreveport Manor, LLC was last updated on August 27, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.