Basic Information
| Provider Information | |||||||||
| NPI: | 1730188558 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROMISE HOSPITAL OF ASCENSION, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 999 YAMATO ROAD | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618693100 | ||||||||
| FaxNumber: | 5618260171 | ||||||||
| Practice Location | |||||||||
| Address1: | 5130 MANCUSO LN | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2254909600 | ||||||||
| FaxNumber: | 2254909690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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| AuthorizedOfficialLastName: | HOPWOOD | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5618693100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | 650 | LA | Y | Hospitals | Long Term Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1748285 | 05 | LA | MEDICAID | 1754439 | 01 | LA | MEDICAID PROF | OTHER | 5D167 | 01 | LA | MEDICARE PROF | OTHER |