Provider Demographics
NPI:1225068950
Name:ST. LUKES REHABILITAION HOSPITAL
Entity Type:Organization
Organization Name:ST. LUKES REHABILITAION HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-493-5565
Mailing Address - Street 1:2140 MIDWAY ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-2206
Mailing Address - Country:US
Mailing Address - Phone:318-631-2345
Mailing Address - Fax:
Practice Address - Street 1:2140 MIDWAY ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-2206
Practice Address - Country:US
Practice Address - Phone:318-631-2345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA547283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1701971Medicaid
LA193083Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER