Provider Demographics
NPI:1093797722
Name:BRPT-LAKE REHABILITATION CENTERS, LLC
Entity Type:Organization
Organization Name:BRPT-LAKE REHABILITATION CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:SR
Authorized Official - Credentials:CPA
Authorized Official - Phone:225-231-3814
Mailing Address - Street 1:530 SHADOWS LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6530
Mailing Address - Country:US
Mailing Address - Phone:225-927-9185
Mailing Address - Fax:225-231-3818
Practice Address - Street 1:503 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6508
Practice Address - Country:US
Practice Address - Phone:225-231-3800
Practice Address - Fax:225-231-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7711822OtherCIGNA PROVIDER NUMBER
LA115726OtherCOVENTRY PROVIDER NUMBER
LA6400005OtherUNITED PROVIDER NUMBER
LA4431096OtherAETNA PROVIDER NUMBER
LAG0052OtherBCBSLA PROVIDER NUMBER
LA6400005OtherUNITED PROVIDER NUMBER