Provider Demographics
NPI:1912115247
Name:GOODWOOD MEDICAL REHAB CENTER, LLC
Entity Type:Organization
Organization Name:GOODWOOD MEDICAL REHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OF LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DREYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-924-6115
Mailing Address - Street 1:8676 GOODWOOD BLVD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7914
Mailing Address - Country:US
Mailing Address - Phone:225-924-6115
Mailing Address - Fax:225-924-3112
Practice Address - Street 1:8676 GOODWOOD BLVD
Practice Address - Street 2:SUITE #101
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7914
Practice Address - Country:US
Practice Address - Phone:225-924-6115
Practice Address - Fax:225-924-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA588111NS0005X
LA06806R2081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Not Answered2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Multi-Specialty