Provider Demographics
NPI:1831343888
Name:MERIDIAN HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:MERIDIAN HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TCHIBINDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-304-3498
Mailing Address - Street 1:3737 GENERAL DEGAULLE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-8205
Mailing Address - Country:US
Mailing Address - Phone:504-304-3498
Mailing Address - Fax:504-304-3491
Practice Address - Street 1:3737 GENERAL DEGAULLE DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-8205
Practice Address - Country:US
Practice Address - Phone:504-304-3498
Practice Address - Fax:504-304-3491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA186372261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2133284Medicaid
LA2133284Medicaid
LA19-4548Medicare PIN