Provider Demographics
NPI:1942209531
Name:EHO2002, LLC
Entity Type:Organization
Organization Name:EHO2002, LLC
Other - Org Name:EASTHAVEN CARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-927-4290
Mailing Address - Street 1:3049 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2277
Mailing Address - Country:US
Mailing Address - Phone:225-927-4290
Mailing Address - Fax:225-927-5385
Practice Address - Street 1:9660 LAKE FOREST BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-2619
Practice Address - Country:US
Practice Address - Phone:504-244-9013
Practice Address - Fax:504-241-5330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1510408Medicaid
LA195339Medicare ID - Type UnspecifiedMEDICARE