Provider Demographics
NPI:1891033403
Name:LOUISIANA REHAB PRODUCTS INC
Entity Type:Organization
Organization Name:LOUISIANA REHAB PRODUCTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:DECASTRO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:504-468-6100
Mailing Address - Street 1:2424 WILLIAMS BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-5763
Mailing Address - Country:US
Mailing Address - Phone:504-468-6100
Mailing Address - Fax:504-468-6109
Practice Address - Street 1:11135 INDUSTRIPLEX BLVD
Practice Address - Street 2:STE 810
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-4114
Practice Address - Country:US
Practice Address - Phone:225-751-9339
Practice Address - Fax:225-751-2751
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISISNA REHAB PRODUCTS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA77610OtherBCBS OF LOUISIANA
LA1998214Medicaid
LA0531230001Medicare NSC