Provider Demographics
NPI:1851619241
Name:BASTROP REHABILITATION HOSPITAL, LLC
Entity Type:Organization
Organization Name:BASTROP REHABILITATION HOSPITAL, LLC
Other - Org Name:RIVERBEND REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:MEANS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:318-422-1640
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:318-742-3408
Mailing Address - Fax:318-752-1940
Practice Address - Street 1:4310 S GRAND ST
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:318-654-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA432283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital