1891033403 NPI number — LOUISIANA REHAB PRODUCTS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891033403 NPI number — LOUISIANA REHAB PRODUCTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISIANA REHAB PRODUCTS INC
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:
1891033403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2424 WILLIAMS BLVD
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
KENNER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70062-5763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-468-6100
Provider Business Mailing Address Fax Number:
504-468-6109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11135 INDUSTRIPLEX BLVD
Provider Second Line Business Practice Location Address:
STE 810
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-4114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-751-9339
Provider Business Practice Location Address Fax Number:
225-751-2751
Provider Enumeration Date:
01/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DECASTRO
Authorized Official First Name:
RICKY
Authorized Official Middle Name:
WALTER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
504-468-6100

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 77610 . This is a "BCBS OF LOUISIANA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1998214 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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