Provider Demographics
NPI:1003920414
Name:BAYOU RAPIDES REHAB, LLC
Entity Type:Organization
Organization Name:BAYOU RAPIDES REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:LINCOLN
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:II
Authorized Official - Credentials:MS
Authorized Official - Phone:318-561-2010
Mailing Address - Street 1:PO BOX 12368
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-2368
Mailing Address - Country:US
Mailing Address - Phone:318-561-2010
Mailing Address - Fax:318-561-0098
Practice Address - Street 1:3620 BAYOU RAPIDES RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3653
Practice Address - Country:US
Practice Address - Phone:318-561-2010
Practice Address - Fax:318-561-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1434507Medicaid