Provider Demographics
NPI:1285649939
Name:ST THERESA HOSPITAL OF KENNER LLC
Entity Type:Organization
Organization Name:ST THERESA HOSPITAL OF KENNER LLC
Other - Org Name:ST THERESA MEDICAL COMPLEX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LILJEBERG
Authorized Official - Suffix:JR
Authorized Official - Credentials:R PH
Authorized Official - Phone:504-885-3900
Mailing Address - Street 1:3900 VETERANS BLVS
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5364
Mailing Address - Country:US
Mailing Address - Phone:504-885-3900
Mailing Address - Fax:504-885-3600
Practice Address - Street 1:3601 LOYOLA DRIVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-1797
Practice Address - Country:US
Practice Address - Phone:504-468-8552
Practice Address - Fax:504-885-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital