Provider Demographics
NPI:1306846050
Name:PREMIER REHABILITATION HOSPITAL, LLC
Entity Type:Organization
Organization Name:PREMIER REHABILITATION HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-993-5711
Mailing Address - Street 1:4310 S GRAND ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-6322
Mailing Address - Country:US
Mailing Address - Phone:318-812-1000
Mailing Address - Fax:318-812-1012
Practice Address - Street 1:4310 S GRAND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-6322
Practice Address - Country:US
Practice Address - Phone:318-812-1000
Practice Address - Fax:318-812-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1702102Medicaid
LA1702102Medicaid