Provider Demographics
NPI:1831198175
Name:GENESIS SPECIALTY HOSPITALS II, LLC
Entity type:Organization
Organization Name:GENESIS SPECIALTY HOSPITALS II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C E O
Authorized Official - Prefix:
Authorized Official - First Name:T
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-445-7344
Mailing Address - Street 1:3918 JACKSON STREET EXT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3007
Mailing Address - Country:US
Mailing Address - Phone:318-445-7344
Mailing Address - Fax:318-484-2865
Practice Address - Street 1:301 N JEFFERSON DAVIS PKWY
Practice Address - Street 2:4 TH FLOOR
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5311
Practice Address - Country:US
Practice Address - Phone:504-486-5841
Practice Address - Fax:504-485-5875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA503282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA282N00000XOtherTAXONOMY NUMBER
LA1762377Medicaid
LA503OtherLA HOSPITAL LICENSE NUMBE
LA192014Medicare ID - Type UnspecifiedPROVIDER NUMBER