Provider Demographics
NPI:1629039193
Name:RIVERSIDE HOSPITAL OF LOUISIANA, INC.
Entity Type:Organization
Organization Name:RIVERSIDE HOSPITAL OF LOUISIANA, INC.
Other - Org Name:RIVERSIDE HOSPITAL OF LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY / TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:MEANS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:318-742-3408
Mailing Address - Street 1:1000 CHINABERRY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2443
Mailing Address - Country:US
Mailing Address - Phone:318-658-9977
Mailing Address - Fax:318-658-9979
Practice Address - Street 1:13 HEYMAN LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3574
Practice Address - Country:US
Practice Address - Phone:318-767-2900
Practice Address - Fax:318-442-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
60554OtherBLUE CROSS
192043Medicare ID - Type Unspecified