Provider Demographics
NPI:1497934327
Name:BEAVER CREEK HEALTH & REHAB CENTER
Entity Type:Organization
Organization Name:BEAVER CREEK HEALTH & REHAB CENTER
Other - Org Name:BEAVER CREEK HEALTH & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:225-664-1456
Mailing Address - Street 1:32350 LA HIGHWAY 16
Mailing Address - Street 2:BLDG C
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-1463
Mailing Address - Country:US
Mailing Address - Phone:225-664-1456
Mailing Address - Fax:866-766-9895
Practice Address - Street 1:32350 LA HIGHWAY 16
Practice Address - Street 2:BLDG C
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-1463
Practice Address - Country:US
Practice Address - Phone:225-664-1456
Practice Address - Fax:866-766-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-27
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1058261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CS93Medicare UPIN
LA5CS93Medicare PIN