Provider Demographics
NPI:1972753192
Name:GRACE HEALTHCARE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:GRACE HEALTHCARE MANAGEMENT, LLC
Other - Org Name:SPECIALTY REHABILITATION HOSPITAL OF LULING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATRENDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-785-5233
Mailing Address - Street 1:P.O. BOX 2604
Mailing Address - Street 2:
Mailing Address - City:LAPLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70069
Mailing Address - Country:US
Mailing Address - Phone:985-785-5233
Mailing Address - Fax:985-785-5181
Practice Address - Street 1:1125 PAUL MAILLARD ROAD
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070
Practice Address - Country:US
Practice Address - Phone:985-785-5233
Practice Address - Fax:985-785-5181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1702005Medicaid
LA1702005Medicaid