Provider Demographics
NPI:1790850378
Name:GULF STATES LONG TERM ACUTE CARE OF NEW ORLEANS, LLC
Entity Type:Organization
Organization Name:GULF STATES LONG TERM ACUTE CARE OF NEW ORLEANS, LLC
Other - Org Name:GULF STATES LTAC OF NEW ORLEANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-216-2299
Mailing Address - Street 1:PO BOX 641600
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70064-1600
Mailing Address - Country:US
Mailing Address - Phone:504-464-8590
Mailing Address - Fax:504-464-8550
Practice Address - Street 1:180 W ESPLANADE AVE
Practice Address - Street 2:FIFTH FLOOR
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2467
Practice Address - Country:US
Practice Address - Phone:504-464-8590
Practice Address - Fax:504-464-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA625282E00000X, 284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1702293Medicaid
LA192015Medicare Oscar/Certification