Provider Demographics
NPI:1245202373
Name:HEALTH SERVICESGROUP OF LOUISIANA, LLC
Entity Type:Organization
Organization Name:HEALTH SERVICESGROUP OF LOUISIANA, LLC
Other - Org Name:GULF STATES LTAC WASHINGTON/ST TAMMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-216-2299
Mailing Address - Street 1:433 PLAZA ST
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3729
Mailing Address - Country:US
Mailing Address - Phone:985-732-1186
Mailing Address - Fax:
Practice Address - Street 1:433 PLAZA ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3729
Practice Address - Country:US
Practice Address - Phone:985-732-1186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA418284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA60745OtherBLUE CROSS BLUE SHIELD
LA60745OtherBLUE CROSS BLUE SHIELD