Provider Demographics
NPI:1477936946
Name:HEALTH REHAB MANAGEMENT GROUP LLC
Entity Type:Organization
Organization Name:HEALTH REHAB MANAGEMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-303-4177
Mailing Address - Street 1:2703 GENERAL DEGAULLE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-6222
Mailing Address - Country:US
Mailing Address - Phone:504-303-4177
Mailing Address - Fax:504-208-3373
Practice Address - Street 1:2074 BECK ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3506
Practice Address - Country:US
Practice Address - Phone:504-234-2267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2403885Medicaid
LA432417OtherMEDICARE PTAN