1093797722 NPI number — BRPT-LAKE REHABILITATION CENTERS, LLC

Table of content: (NPI 1093797722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093797722 NPI number — BRPT-LAKE REHABILITATION CENTERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRPT-LAKE REHABILITATION CENTERS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093797722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 SHADOWS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70806-6530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-927-9185
Provider Business Mailing Address Fax Number:
225-231-3818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 COLONIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-6508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-231-3800
Provider Business Practice Location Address Fax Number:
225-231-3803
Provider Enumeration Date:
11/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GALLEGOS
Authorized Official First Name:
MELANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
225-231-3814

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7711822 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 115726 . This is a "COVENTRY PROVIDER NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 6400005 . This is a "UNITED PROVIDER NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 4431096 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: G0052 . This is a "BCBSLA PROVIDER NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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