1336232396 NPI number — RUSTON NEUROPSYCHIATRIC HOSPITAL

Table of content: (NPI 1336232396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336232396 NPI number — RUSTON NEUROPSYCHIATRIC HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUSTON NEUROPSYCHIATRIC HOSPITAL
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:
1336232396
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:
146 SHAMAN ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71270-1012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-254-0142
Provider Business Mailing Address Fax Number:
318-254-2829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
146 SHAMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71270-5347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-254-0142
Provider Business Practice Location Address Fax Number:
318-254-2829
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VANDENBERG
Authorized Official First Name:
ELISE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
318-251-2322

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  565 , 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: 1709573 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com