Provider Demographics
NPI:1457437816
Name:LOUISIANA REHAB PRODUCTS INC.
Entity type:Organization
Organization Name:LOUISIANA REHAB PRODUCTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:DECASTRO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:504-468-6100
Mailing Address - Street 1:2424 WILLIAMS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-5763
Mailing Address - Country:US
Mailing Address - Phone:504-468-6100
Mailing Address - Fax:504-468-6109
Practice Address - Street 1:2424 WILLIAMS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-5763
Practice Address - Country:US
Practice Address - Phone:504-468-6100
Practice Address - Fax:504-468-6109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA77610OtherBLUE CROSS BLUE SHIELD OF LOUISIANA
LA1998214Medicaid
LA77610OtherBLUE CROSS BLUE SHIELD OF LOUISIANA