Provider Demographics
NPI:1902359870
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:
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:SUITE 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 1:7030 CANAL BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-3410
Practice Address - Country:US
Practice Address - Phone:504-468-6100
Practice Address - Fax:504-468-6109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISIANA REHAB PRODUCTS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA77610OtherBCBS OF LOUISIANA
LA1998214Medicaid
LA1998214Medicaid