Provider Demographics
NPI:1003174830
Name:NEUROLOGICAL REHABILITATION LIVING CENTERS OF LOUISIANA
Entity Type:Organization
Organization Name:NEUROLOGICAL REHABILITATION LIVING CENTERS OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CBIS, CCM
Authorized Official - Phone:985-875-3100
Mailing Address - Street 1:614 W 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3063
Mailing Address - Country:US
Mailing Address - Phone:985-875-3100
Mailing Address - Fax:985-875-3103
Practice Address - Street 1:614 W 18TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3063
Practice Address - Country:US
Practice Address - Phone:985-875-3100
Practice Address - Fax:985-875-3103
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROLOGICAL REHABILITATION LIVING CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-30
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA003261QD1600X, 261QR0400X, 283X00000X, 320700000X, 385H00000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Yes283X00000XHospitalsRehabilitation Hospital
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No385H00000XRespite Care FacilityRespite Care