Provider Demographics
NPI:1205809431
Name:RENAISSANCE REHABILITATION CENTER OF HOUMA, INC
Entity type:Organization
Organization Name:RENAISSANCE REHABILITATION CENTER OF HOUMA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERON
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:985-876-9555
Mailing Address - Street 1:1322 SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3961
Mailing Address - Country:US
Mailing Address - Phone:985-876-9555
Mailing Address - Fax:985-876-0180
Practice Address - Street 1:1322 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3961
Practice Address - Country:US
Practice Address - Phone:985-876-9555
Practice Address - Fax:985-876-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00677225100000X
LAZ10831225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB7842OtherBLUE CROSS INSURANCE NO
LA1124401Medicaid
LA196600Medicare ID - Type Unspecified