Provider Demographics
NPI:1558388470
Name:BETHESDA REHABILITATION HOSPITAL, INC.
Entity Type:Organization
Organization Name:BETHESDA REHABILITATION HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:985-653-0950
Mailing Address - Street 1:501 RUE DE SANTE, SUITE 12
Mailing Address - Street 2:
Mailing Address - City:LAPLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068
Mailing Address - Country:US
Mailing Address - Phone:985-653-0950
Mailing Address - Fax:985-653-0190
Practice Address - Street 1:7414 SUMRALL DRIVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70812
Practice Address - Country:US
Practice Address - Phone:225-767-2034
Practice Address - Fax:225-767-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA675283X00000X
LA193092283X00000X
283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1704237Medicaid
LA193092Medicare ID - Type Unspecified