Provider Demographics
NPI:1902841570
Name:SHAMA PULMONARY REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:SHAMA PULMONARY REHABILITATION CENTER INC
Other - Org Name:SHAMA RESPIRATORY SERVICES & HME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:FOURROUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-428-8233
Mailing Address - Street 1:PO BOX 676
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-0676
Mailing Address - Country:US
Mailing Address - Phone:318-428-8233
Mailing Address - Fax:
Practice Address - Street 1:212 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:LA
Practice Address - Zip Code:71263-2535
Practice Address - Country:US
Practice Address - Phone:318-428-8233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALT3348332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1457485Medicaid
LA1457485Medicaid