1811049943 NPI number — REHABILITATION SPECIALTY EQUIPMENT LLC

Table of content: (NPI 1811049943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811049943 NPI number — REHABILITATION SPECIALTY EQUIPMENT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATION SPECIALTY EQUIPMENT 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:
1811049943
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9311 BLUEBONNET BLVD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70810-2970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-767-2370
Provider Business Mailing Address Fax Number:
225-767-2065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9311 BLUEBONNET BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70810-2970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-767-2370
Provider Business Practice Location Address Fax Number:
225-767-2065
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HENRIKSEN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
ERIC
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
225-281-3800

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8200171 . This is a "UNITED HEALTH" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 360870 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2100947 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 611857600 . This is a "U.S. LABOR DEPT." identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: G0700 . This is a "BLUE CROSS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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