1790850378 NPI number — GULF STATES LONG TERM ACUTE CARE OF NEW ORLEANS, LLC

Table of content: (NPI 1790850378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790850378 NPI number — GULF STATES LONG TERM ACUTE CARE OF NEW ORLEANS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GULF STATES LONG TERM ACUTE CARE OF NEW ORLEANS, 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:
1790850378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 641600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70064-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-464-8590
Provider Business Mailing Address Fax Number:
504-464-8550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 W ESPLANADE AVE
Provider Second Line Business Practice Location Address:
FIFTH FLOOR
Provider Business Practice Location Address City Name:
KENNER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70065-2467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-464-8590
Provider Business Practice Location Address Fax Number:
504-464-8550
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
225-216-2299

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  625 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 284300000X , with the licence number: 625 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1702293 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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