Provider Demographics
NPI:1225321474
Name:LIFECARE SPECIALTY HOSPITAL OF NORTH LOUISIANA LLC
Entity Type:Organization
Organization Name:LIFECARE SPECIALTY HOSPITAL OF NORTH LOUISIANA LLC
Other - Org Name:LIFECARE SPECIALTY HOSPITAL OF NORTH LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:469-241-2128
Mailing Address - Street 1:5340 LEGACY DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3178
Mailing Address - Country:US
Mailing Address - Phone:469-241-2100
Mailing Address - Fax:
Practice Address - Street 1:1401 EZELLE ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-7218
Practice Address - Country:US
Practice Address - Phone:318-251-3126
Practice Address - Fax:318-251-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1763152Medicaid
LA192022Medicare Oscar/Certification