1801099825 NPI number — LOUISIANA HEALTH AND REHAB CENTER INC

Table of content: RONNIE PETER IABONI LCSW (NPI 1427096072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801099825 NPI number — LOUISIANA HEALTH AND REHAB CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISIANA HEALTH AND REHAB CENTER INC
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:
1801099825
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:
1033 N LOBDELL AVE
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:
70806-2233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-231-2490
Provider Business Mailing Address Fax Number:
225-231-2857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1033 N LOBDELL AVE
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:
70806-2233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-231-2490
Provider Business Practice Location Address Fax Number:
225-231-2857
Provider Enumeration Date:
06/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TEMPLE
Authorized Official First Name:
SOUNDRA
Authorized Official Middle Name:
JOHNSON
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
225-938-0661

Provider Taxonomy Codes

  • Taxonomy code: 103TM1800X , with the licence number:  SIL 9505 , 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: 1152358 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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