Provider Demographics
NPI:1619629763
Name:PATHWAY REHABILITATION HOSPITAL OF BOSSIER, LLC
Entity Type:Organization
Organization Name:PATHWAY REHABILITATION HOSPITAL OF BOSSIER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-841-5555
Mailing Address - Street 1:4900 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4521
Mailing Address - Country:US
Mailing Address - Phone:318-841-5555
Mailing Address - Fax:318-841-5563
Practice Address - Street 1:4900 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4521
Practice Address - Country:US
Practice Address - Phone:318-841-5555
Practice Address - Fax:318-841-5563
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAY REHABILITATION HOSPITAL OF BOSSIER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility