1609891118 NPI number — ST CHARLES SPECIALTY REHABILITATION HOSPITAL LLC

Table of content: (NPI 1609891118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609891118 NPI number — ST CHARLES SPECIALTY REHABILITATION HOSPITAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST CHARLES SPECIALTY REHABILITATION HOSPITAL 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:
LULING REHABILITATION HOSPITAL LLC
Provider Other Organization Name Type Code:
4
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:
1609891118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 BARONNE ST APT 716
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70112-1745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-626-3295
Provider Business Mailing Address Fax Number:
225-224-6238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8375 FLORIDA BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DENHAM SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70726-7806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-665-7100
Provider Business Practice Location Address Fax Number:
225-665-7105
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BONDS
Authorized Official First Name:
JUANITA
Authorized Official Middle Name:
BATES
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
470-626-3295

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X , with the licence number:  439 , 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: 60231 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1767760 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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