Provider Demographics
NPI:1922139831
Name:RUSTON LOUISIANA HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:RUSTON LOUISIANA HOSPITAL COMPANY LLC
Other - Org Name:NORTHERN LOUISIANA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-925-4565
Mailing Address - Street 1:401 E VAUGHN AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5950
Mailing Address - Country:US
Mailing Address - Phone:318-254-2100
Mailing Address - Fax:318-254-2728
Practice Address - Street 1:401 E VAUGHN AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5950
Practice Address - Country:US
Practice Address - Phone:318-254-2100
Practice Address - Fax:318-254-2728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSTON LOUISIANA HOSPITAL COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-09
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA618314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA195269Medicare Oscar/Certification