Provider Demographics
NPI:1407036379
Name:DIVERSIFIED REHABILITATION SERVICE
Entity Type:Organization
Organization Name:DIVERSIFIED REHABILITATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-810-6130
Mailing Address - Street 1:2900 WESTFORK DR STE 42
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70827-0010
Mailing Address - Country:US
Mailing Address - Phone:225-756-2700
Mailing Address - Fax:
Practice Address - Street 1:19637 CAPE HART CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-6727
Practice Address - Country:US
Practice Address - Phone:225-756-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12265251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services