Provider Demographics
NPI:1497805923
Name:CANE RIVER PHYSICAL MEDICINE & REHABILITATION LLC
Entity Type:Organization
Organization Name:CANE RIVER PHYSICAL MEDICINE & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEAIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:318-238-3045
Mailing Address - Street 1:224 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5041
Mailing Address - Country:US
Mailing Address - Phone:318-238-3045
Mailing Address - Fax:
Practice Address - Street 1:224 SOUTH DR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5041
Practice Address - Country:US
Practice Address - Phone:318-238-3045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1458368Medicaid
LA5915260001Medicare NSC
LA5CW47Medicare PIN
LA1458368Medicaid