Provider Demographics
NPI:1558726828
Name:HALCYON REHAB
Entity Type:Organization
Organization Name:HALCYON REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BROGGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-287-6802
Mailing Address - Street 1:36020 WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-1523
Mailing Address - Country:US
Mailing Address - Phone:504-287-6802
Mailing Address - Fax:
Practice Address - Street 1:36020 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706-1523
Practice Address - Country:US
Practice Address - Phone:504-287-6802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA8334311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home