Provider Demographics
NPI:1659862324
Name:LOUISIANA INSTITUTE OF REHABILITATIVE SERVICES
Entity Type:Organization
Organization Name:LOUISIANA INSTITUTE OF REHABILITATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, MBA
Authorized Official - Phone:804-514-9696
Mailing Address - Street 1:6019 DUBLIN RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-5237
Mailing Address - Country:US
Mailing Address - Phone:804-514-9696
Mailing Address - Fax:
Practice Address - Street 1:6019 DUBLIN RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-5237
Practice Address - Country:US
Practice Address - Phone:804-514-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health