Provider Demographics
NPI:1396854543
Name:LIFECARE HOSPITAL OF NEW ORLEANS AT KENNER
Entity Type:Organization
Organization Name:LIFECARE HOSPITAL OF NEW ORLEANS AT KENNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-241-2128
Mailing Address - Street 1:5560 TENNYSON PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3532
Mailing Address - Country:US
Mailing Address - Phone:469-241-2128
Mailing Address - Fax:469-241-2177
Practice Address - Street 1:180 W ESPLANADE AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2467
Practice Address - Country:US
Practice Address - Phone:504-464-8590
Practice Address - Fax:504-464-8062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA482282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1763616Medicaid
19-2038Medicare ID - Type Unspecified