Provider Demographics
NPI:1437467305
Name:CAMILLUS SPECIALTY HOSPITAL LLC
Entity Type:Organization
Organization Name:CAMILLUS SPECIALTY HOSPITAL LLC
Other - Org Name:CRESCENT CITY SPECIALTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-841-2209
Mailing Address - Street 1:804 N CAUSEWAY BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5364
Mailing Address - Country:US
Mailing Address - Phone:504-841-2209
Mailing Address - Fax:504-828-8025
Practice Address - Street 1:535 COMMERCE ST
Practice Address - Street 2:STE B
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7316
Practice Address - Country:US
Practice Address - Phone:504-391-1500
Practice Address - Fax:504-391-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
192014Medicare Oscar/Certification