1538402748 NPI number — NEW LIFECARE SPECIALTY HOSPITAL OF NORTH LOUISIANA LLC

Table of content: (NPI 1538402748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538402748 NPI number — NEW LIFECARE SPECIALTY HOSPITAL OF NORTH LOUISIANA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW LIFECARE SPECIALTY HOSPITAL OF NORTH LOUISIANA 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:
1538402748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 CHINABERRY DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSSIER CITY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71111-2443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-658-9977
Provider Business Mailing Address Fax Number:
318-658-9979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 EZELLE ST
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:
71270-7218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-251-3126
Provider Business Practice Location Address Fax Number:
318-251-1594
Provider Enumeration Date:
04/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GRAS
Authorized Official First Name:
SUZIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING OFFICE MANAGER
Authorized Official Telephone Number:
318-658-9977

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  2203781834 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282E00000X , with the licence number: 699 , 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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