Provider Demographics
NPI:1760961338
Name:BASTROP REHABILITATION HOSPITAL, LLC
Entity Type:Organization
Organization Name:BASTROP REHABILITATION HOSPITAL, LLC
Other - Org Name:SOUTH OUACHITA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MEANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-746-0420
Mailing Address - Street 1:816 BENTON RD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3744
Mailing Address - Country:US
Mailing Address - Phone:318-747-8895
Mailing Address - Fax:318-752-1940
Practice Address - Street 1:4310 S GRAND ST STE 1
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-6322
Practice Address - Country:US
Practice Address - Phone:318-654-8920
Practice Address - Fax:318-654-8921
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BASTROP REHABILITATION HOSPITAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service