Provider Demographics
NPI:1962839134
Name:LOUISIANA REHAB PRODUCTS INC
Entity Type:Organization
Organization Name:LOUISIANA REHAB PRODUCTS INC
Other - Org Name:LA REHAB
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:W
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 1:2424 WILLIAMS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-5763
Practice Address - Country:US
Practice Address - Phone:504-468-6100
Practice Address - Fax:504-468-6109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1998214Medicaid
0531230001Medicare PIN