1558639328 NPI number — LOUISIANA HEALTH & REHABILITATION COPTIONS

Table of content: (NPI 1558639328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558639328 NPI number — LOUISIANA HEALTH & REHABILITATION COPTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISIANA HEALTH & REHABILITATION COPTIONS
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:
1558639328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2121 WOODDALE BLVD
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:
70806-1442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-231-2490
Provider Business Mailing Address Fax Number:
225-231-2775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 OCEAN DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-4618
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:
225-231-2775
Provider Enumeration Date:
12/08/2011

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  PCA 15147 , 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: 1954748 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1453781 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2130021 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1177482 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1453773 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1653187 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2130005 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2129970 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1171727 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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