Provider Demographics
NPI:1972575009
Name:HAMMOND REHABILITATION HOSPITAL, LLC
Entity Type:Organization
Organization Name:HAMMOND REHABILITATION HOSPITAL, LLC
Other - Org Name:GULF STATES LTAC OF HAMMOND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND COO
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-216-2299
Mailing Address - Street 1:42074 VETERANS AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1408
Mailing Address - Country:US
Mailing Address - Phone:985-902-8148
Mailing Address - Fax:985-902-9148
Practice Address - Street 1:42074 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1408
Practice Address - Country:US
Practice Address - Phone:985-902-8148
Practice Address - Fax:985-902-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA446282E00000X, 284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA60737OtherBCBS
LA1710814Medicaid
LA1710814Medicaid