Provider Demographics
NPI:1740446848
Name:MEADOWCREST NURSING AND REHABILITATION, LLC
Entity type:Organization
Organization Name:MEADOWCREST NURSING AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-464-7010
Mailing Address - Street 1:535 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7316
Mailing Address - Country:US
Mailing Address - Phone:504-393-9595
Mailing Address - Fax:504-392-8899
Practice Address - Street 1:535 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7316
Practice Address - Country:US
Practice Address - Phone:504-393-9595
Practice Address - Fax:504-392-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1521205Medicaid
LA1521205Medicaid