Basic Information
| Provider Information | |||||||||
| NPI: | 1225321474 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFECARE SPECIALTY HOSPITAL OF NORTH LOUISIANA LLC | ||||||||
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| OtherOrganizationName: | LIFECARE SPECIALTY HOSPITAL OF NORTH LOUISIANA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5340 LEGACY DR | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750243178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692412100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1401 EZELLE ST | ||||||||
| Address2: | |||||||||
| City: | RUSTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712707218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182513126 | ||||||||
| FaxNumber: | 3182511594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2011 | ||||||||
| LastUpdateDate: | 06/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | CRONIN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4692412128 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | LA | Y | Hospitals | Long Term Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1763152 | 05 | LA | MEDICAID |