Provider Demographics
NPI:1053684381
Name:LOUISIANA HEALTH AND REHAB CENTER INC
Entity Type:Organization
Organization Name:LOUISIANA HEALTH AND REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SOUNDRA
Authorized Official - Middle Name:TEMPLE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-231-2490
Mailing Address - Street 1:2121 WOODDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1442
Mailing Address - Country:US
Mailing Address - Phone:225-231-2490
Mailing Address - Fax:225-231-2775
Practice Address - Street 1:2056 NORTH BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3674
Practice Address - Country:US
Practice Address - Phone:225-343-3438
Practice Address - Fax:225-343-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA420324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2118161Medicaid