Provider Demographics
NPI:1316180706
Name:LTAC HOSPITAL OF FELICIANA, LLC
Entity Type:Organization
Organization Name:LTAC HOSPITAL OF FELICIANA, LLC
Other - Org Name:ZACHARY - AMG SPECIALTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUST
Authorized Official - Middle Name:J
Authorized Official - Last Name:RANTZ
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:337-269-9566
Mailing Address - Street 1:101 LA RUE FRANCE STE 500
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3144
Mailing Address - Country:US
Mailing Address - Phone:337-269-9566
Mailing Address - Fax:337-269-9823
Practice Address - Street 1:4601 MCHUGH RD
Practice Address - Street 2:BLDG B
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-5348
Practice Address - Country:US
Practice Address - Phone:225-683-1600
Practice Address - Fax:225-683-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA192041Medicare Oscar/Certification