Provider Demographics
NPI:1821223991
Name:BOSSIER SPECIALTY HOSPITAL ,LLC
Entity Type:Organization
Organization Name:BOSSIER SPECIALTY HOSPITAL ,LLC
Other - Org Name:BOSSIER SPECIALTY HOSPITAL OASIS PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:318-549-2011
Mailing Address - Street 1:2105 AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3105
Mailing Address - Country:US
Mailing Address - Phone:318-549-2011
Mailing Address - Fax:318-549-2077
Practice Address - Street 1:2105 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3105
Practice Address - Country:US
Practice Address - Phone:318-549-2011
Practice Address - Fax:318-549-2077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSSIER SPECIALTY HOSPITAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA512282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1702650Medicaid
LA1702650Medicaid