Provider Demographics
NPI:1609203819
Name:NOLA REHABILITATION SPECIALIST, LLC
Entity Type:Organization
Organization Name:NOLA REHABILITATION SPECIALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-773-8631
Mailing Address - Street 1:15533 LAKE RAMSEY RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-5758
Mailing Address - Country:US
Mailing Address - Phone:985-773-8631
Mailing Address - Fax:866-805-8554
Practice Address - Street 1:15533 LAKE RAMSEY RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-5758
Practice Address - Country:US
Practice Address - Phone:985-773-8631
Practice Address - Fax:866-805-8554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies