Provider Demographics
NPI:1891757670
Name:LAFAYETTE COMMUNITY REHABILITATION HOSPITAL, LLC
Entity Type:Organization
Organization Name:LAFAYETTE COMMUNITY REHABILITATION HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DYSON
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-234-4031
Mailing Address - Street 1:408 SE EVANGELINE THRUWAY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501
Mailing Address - Country:US
Mailing Address - Phone:337-234-4031
Mailing Address - Fax:337-210-1558
Practice Address - Street 1:408 SE EVANGELINE THRUWAY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501
Practice Address - Country:US
Practice Address - Phone:337-234-4031
Practice Address - Fax:337-210-1558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA592282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA61229OtherBLUE CROSS OF LA
LA1763519Medicaid
LA192020Medicare ID - Type Unspecified
LA1763519Medicaid