Basic Information
| Provider Information | |||||||||
| NPI: | 1083162465 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHABILITATION SERVICES OF CENTRAL LOUISIANA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 816 BENTON RD | ||||||||
| Address2: | |||||||||
| City: | BOSSIER CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711113744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187423408 | ||||||||
| FaxNumber: | 3188411210 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 BIENVILLE ST | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | NATCHITOCHES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714575737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183579009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2016 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | MUDD | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3187423408 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.