1427343607 NPI number — LOUISIANA REENTRY & REHABILITATION SERVICES 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 1427343607 NPI number — LOUISIANA REENTRY & REHABILITATION SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISIANA REENTRY & REHABILITATION SERVICES 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:
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:
1427343607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1116 JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71202-2024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-325-1506
Provider Business Mailing Address Fax Number:
318-325-1585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1116 JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71202-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-325-1506
Provider Business Practice Location Address Fax Number:
318-325-1585
Provider Enumeration Date:
06/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
THEUS
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
318-614-1598

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: STATE LICENSE NUMBER . This is a "STATE LICENSE NUMBER 331" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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