Provider Demographics
NPI:1881628097
Name:LAFAYETTE PHYSICAL REHABILITATION HOSPITAL, LLC
Entity type:Organization
Organization Name:LAFAYETTE PHYSICAL REHABILITATION HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-269-9566
Mailing Address - Street 1:101 LA RUE FRANCE
Mailing Address - Street 2:STE 500
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-269-9566
Mailing Address - Fax:337-234-1075
Practice Address - Street 1:307 POLLY LANE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-314-1111
Practice Address - Fax:337-314-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA589283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA61380OtherBLUE CROSS BLUE SHIELD
LA193093Medicare PIN
LA61380OtherBLUE CROSS BLUE SHIELD