Provider Demographics
NPI:1689878589
Name:RAPIDES HEALTHCARE SYSTEM LLC
Entity Type:Organization
Organization Name:RAPIDES HEALTHCARE SYSTEM LLC
Other - Org Name:FAIR OAKS OF EVANGELINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-468-0355
Mailing Address - Street 1:801 POINCIANA AVE
Mailing Address - Street 2:
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554
Mailing Address - Country:US
Mailing Address - Phone:337-457-9242
Mailing Address - Fax:337-457-9338
Practice Address - Street 1:735 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586
Practice Address - Country:US
Practice Address - Phone:337-363-2471
Practice Address - Fax:337-363-2489
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAPIDES HEALTHCARE SYSTEM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-13
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009158207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1032450Medicaid