1396970810 NPI number — LTAC HOSPITAL OF WASHINGTON-ST. TAMMANY LLC

Table of content: DR. PATRICE ALANA JACOB PH.D. (NPI 1669919148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396970810 NPI number — LTAC HOSPITAL OF WASHINGTON-ST. TAMMANY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LTAC HOSPITAL OF WASHINGTON-ST. TAMMANY 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:
6
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:
1396970810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 LA RUE FRANCE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70508-3144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-269-9828
Provider Business Mailing Address Fax Number:
337-234-1075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 LINDBERG DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLIDELL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70458-8056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-326-0440
Provider Business Practice Location Address Fax Number:
985-326-0559
Provider Enumeration Date:
05/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HARGRAVE
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
337-269-9828

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  584B , 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)





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