Provider Demographics
NPI:1578517207
Name:BERNICE COMMUNITY REHAB HOSPITAL
Entity Type:Organization
Organization Name:BERNICE COMMUNITY REHAB HOSPITAL
Other - Org Name:COMMUNITY SPECIALTY HOSPITAL OF NORTH LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:OSBORNE
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-377-5555
Mailing Address - Street 1:108 MEADOWBROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055
Mailing Address - Country:US
Mailing Address - Phone:318-377-5555
Mailing Address - Fax:
Practice Address - Street 1:108 MEADOWBROOK DRIVE
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055
Practice Address - Country:US
Practice Address - Phone:318-377-5555
Practice Address - Fax:318-377-5442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA61273OtherBLUE CROSS BLUE SHIELD
LA1765422Medicaid
LA192026Medicare ID - Type Unspecified