Provider Demographics
NPI:1962841197
Name:POST ACUTE SPECIALTY HOSPITAL OF LAFAYETTE LLC
Entity Type:Organization
Organization Name:POST ACUTE SPECIALTY HOSPITAL OF LAFAYETTE LLC
Other - Org Name:PAM SPECIALTY HOSPITAL OF LAFAYETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MISITANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-731-9660
Mailing Address - Street 1:1828 GOOD HOPE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1233
Mailing Address - Country:US
Mailing Address - Phone:717-731-9660
Mailing Address - Fax:717-731-9665
Practice Address - Street 1:204 ENERGY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3816
Practice Address - Country:US
Practice Address - Phone:804-204-1537
Practice Address - Fax:804-254-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1762989Medicaid
LA192033Medicare Oscar/Certification