Provider Demographics
NPI:1831171628
Name:GULF STATES LONG TERM ACUTE CARE OF DENHAM SPRINGS, LLC
Entity type:Organization
Organization Name:GULF STATES LONG TERM ACUTE CARE OF DENHAM SPRINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-216-2299
Mailing Address - Street 1:8375 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-7806
Mailing Address - Country:US
Mailing Address - Phone:225-665-2664
Mailing Address - Fax:225-665-0736
Practice Address - Street 1:8375 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-7806
Practice Address - Country:US
Practice Address - Phone:225-665-2664
Practice Address - Fax:225-665-0736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA530284300000X, 282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA60738OtherBLUE CROSS OF LA.
LA1749036Medicaid
LA192008Medicare Oscar/Certification