Provider Demographics
NPI:1336514199
Name:NEW LIFECARE SPECIALTY HOSPITAL OF NORTH LOUISIANA LLC
Entity Type:Organization
Organization Name:NEW LIFECARE SPECIALTY HOSPITAL OF NORTH LOUISIANA LLC
Other - Org Name:RUSTON REGIONAL SPECIALTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT-OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:KEMP
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-658-9977
Mailing Address - Street 1:1000 CHINABERRY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2443
Mailing Address - Country:US
Mailing Address - Phone:318-658-9977
Mailing Address - Fax:318-658-9979
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:2015-12-04
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA192022Medicare Oscar/Certification