Provider Demographics
NPI:1609891118
Name:ST CHARLES SPECIALTY REHABILITATION HOSPITAL LLC
Entity Type:Organization
Organization Name:ST CHARLES SPECIALTY REHABILITATION HOSPITAL LLC
Other - Org Name:LULING REHABILITATION HOSPITAL LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:BATES
Authorized Official - Last Name:BONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-626-3295
Mailing Address - Street 1:210 BARONNE ST APT 716
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1745
Mailing Address - Country:US
Mailing Address - Phone:470-626-3295
Mailing Address - Fax:225-224-6238
Practice Address - Street 1:8375 FLORIDA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-7806
Practice Address - Country:US
Practice Address - Phone:225-665-7100
Practice Address - Fax:225-665-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA439283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA60231OtherBLUE CROSS BLUE SHIELD
LA1767760Medicaid
LA1767760Medicaid