Provider Demographics
NPI:1417930751
Name:PAM II OF COVINGTON, LLC
Entity Type:Organization
Organization Name:PAM II OF COVINGTON, LLC
Other - Org Name:PAM HEALTH SPECIALTY AND REHABILITATION HOSPITAL OF COVINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KARICK
Authorized Official - Middle Name:
Authorized Official - Last Name:STOBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-731-9660
Mailing Address - Street 1:1828 GOOD HOPE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1233
Mailing Address - Country:US
Mailing Address - Phone:717-731-9660
Mailing Address - Fax:
Practice Address - Street 1:20050 CRESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5207
Practice Address - Country:US
Practice Address - Phone:985-902-8148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273Y00000X, 283X00000X
LA680282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No273Y00000XHospital UnitsRehabilitation Unit
No283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA60739OtherBLUE CROSS OF LA
LA1703176Medicaid
MS09326820Medicaid
LA192048Medicare Oscar/Certification