Basic Information
| Provider Information | |||||||||
| NPI: | 1598344848 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTENSIVE SPECIALTY HOSPITAL, LLC | ||||||||
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| OtherOrganizationName: | NORTH LOUISIANA WHOLE HEALTH TREATMENT CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1513 LINE AVENUE | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711014621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184254096 | ||||||||
| FaxNumber: | 3184242627 | ||||||||
| Practice Location | |||||||||
| Address1: | 1513 LINE AVENUE | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711014621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184254096 | ||||||||
| FaxNumber: | 3184242627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2021 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | ROTTENBERG | ||||||||
| AuthorizedOfficialFirstName: | CHAIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSET MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3475225970 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.