Provider Demographics
NPI:1821187758
Name:EAST BATON ROUGE MEDICAL CENTER REHAB
Entity Type:Organization
Organization Name:EAST BATON ROUGE MEDICAL CENTER REHAB
Other - Org Name:OCHSNER MEDICAL CENTER BATON ROUGE REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PFS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-752-2470
Mailing Address - Street 1:17000 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3246
Mailing Address - Country:US
Mailing Address - Phone:225-752-2470
Mailing Address - Fax:225-755-4915
Practice Address - Street 1:17000 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3246
Practice Address - Country:US
Practice Address - Phone:225-752-2470
Practice Address - Fax:225-755-4915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA60910OtherBLUE CROSS REHAB
LA1700797Medicaid
LA60910OtherBLUE CROSS REHAB