Provider Demographics
NPI:1073818399
Name:PREMIER REHAB
Entity type:Organization
Organization Name:PREMIER REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-644-7044
Mailing Address - Street 1:211 E WORTHY ST
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4232
Mailing Address - Country:US
Mailing Address - Phone:225-644-7044
Mailing Address - Fax:225-644-4414
Practice Address - Street 1:1125 PAUL MAILLARD RD
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4351
Practice Address - Country:US
Practice Address - Phone:985-785-8271
Practice Address - Fax:985-785-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1841311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home