Basic Information
| Provider Information | |||||||||
| NPI: | 1447396247 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RIVERSOUTH REHABILITATION CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | N/A | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 N 9TH ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712015513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184101062 | ||||||||
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| Practice Location | |||||||||
| Address1: | 410 S FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | BASTROP | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712204533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184101062 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 04/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | EUBANKS | ||||||||
| AuthorizedOfficialFirstName: | ASHLEY | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING | ||||||||
| AuthorizedOfficialTelephone: | 3184101062 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | LA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1565563 | 05 | LA | MEDICAID | 1529079 | 05 | LA | MEDICAID |