1912115247 NPI number — GOODWOOD MEDICAL REHAB CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912115247 NPI number — GOODWOOD MEDICAL REHAB CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOODWOOD MEDICAL REHAB CENTER, 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:
1912115247
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:
8676 GOODWOOD BLVD
Provider Second Line Business Mailing Address:
SUITE #101
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70806-7914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-924-6115
Provider Business Mailing Address Fax Number:
225-924-3112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8676 GOODWOOD BLVD
Provider Second Line Business Practice Location Address:
SUITE #101
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-7914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-924-6115
Provider Business Practice Location Address Fax Number:
225-924-3112
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DREYER
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
MEMBER OF LLC
Authorized Official Telephone Number:
225-924-6115

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  588 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2081H0002X , with the licence number: 06806R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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