1831198175 NPI number — GENESIS SPECIALTY HOSPITALS II, LLC

Table of content: (NPI 1831198175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831198175 NPI number — GENESIS SPECIALTY HOSPITALS II, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS SPECIALTY HOSPITALS II, 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:
1831198175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3918 JACKSON STREET EXT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71303-3007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-445-7344
Provider Business Mailing Address Fax Number:
318-484-2865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 N JEFFERSON DAVIS PKWY
Provider Second Line Business Practice Location Address:
4 TH FLOOR
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70119-5311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-486-5841
Provider Business Practice Location Address Fax Number:
504-485-5875
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
T
Authorized Official Middle Name:
G
Authorized Official Title or Position:
C E O
Authorized Official Telephone Number:
318-445-7344

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  503 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 282N00000X . This is a "TAXONOMY NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1762377 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 503 . This is a "LA HOSPITAL LICENSE NUMBE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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