Basic Information
| Provider Information | |||||||||
| NPI: | 1548492796 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROCKWALL BATON ROUGE REHABILITATION HOSPITAL, LP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SAGE REHABILITATION HOSPITAL SKILLED NURSING FACILITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 E CAMPBELL RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750816708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724791380 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8000 SUMMA AVE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2258190703 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2009 | ||||||||
| LastUpdateDate: | 08/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | GRANDEAU | ||||||||
| AuthorizedOfficialFirstName: | JACKIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 9724791380 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | VICE PRESIDENT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 653 | LA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 653 | 01 | LA | LA LICENSE | OTHER |