Basic Information
| Provider Information | |||||||||
| NPI: | 1063809556 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MORNING STAR HEALTH REHAB SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MORNING STAR HEALTH REHAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3173 WASHINGTON AVENUE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257787678 | ||||||||
| FaxNumber: | 2253416825 | ||||||||
| Practice Location | |||||||||
| Address1: | 3173 WASHINGTON AVENUE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257787678 | ||||||||
| FaxNumber: | 2253416825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2015 | ||||||||
| LastUpdateDate: | 12/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JACKSON | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR/CEO | ||||||||
| AuthorizedOfficialTelephone: | 2257787678 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 2203783089 | LA | Y | Agencies | Community/Behavioral Health |
No ID Information.