Provider Demographics
NPI:1295776680
Name:PROGRESSIVE ACUTE CARE OAKDALE, LLC
Entity type:Organization
Organization Name:PROGRESSIVE ACUTE CARE OAKDALE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-624-7401
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-0629
Mailing Address - Country:US
Mailing Address - Phone:318-335-3700
Mailing Address - Fax:318-215-3024
Practice Address - Street 1:504 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:LA
Practice Address - Zip Code:70638
Practice Address - Country:US
Practice Address - Phone:318-335-3700
Practice Address - Fax:318-215-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6112672294OtherBCBS
LA1797171Medicaid
LA6112672294OtherBCBS