Provider Demographics
NPI:1225025802
Name:HOSPITAL SERVICE DISTRICT #1 OF EAST BATON ROUGE PARISH
Entity Type:Organization
Organization Name:HOSPITAL SERVICE DISTRICT #1 OF EAST BATON ROUGE PARISH
Other - Org Name:LANE NURSING HOME AN AFFILIATE OF LANE REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-658-4505
Mailing Address - Street 1:6300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4037
Mailing Address - Country:US
Mailing Address - Phone:225-658-4345
Mailing Address - Fax:225-658-4192
Practice Address - Street 1:6300 MAIN ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4037
Practice Address - Country:US
Practice Address - Phone:225-658-4345
Practice Address - Fax:225-658-4192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANE REGIONAL MEDICAL CENTER-SKILLED NURSING FACILITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-29
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA148313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1511374Medicaid