Basic Information
| Provider Information | |||||||||
| NPI: | 1760961338 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BASTROP REHABILITATION HOSPITAL, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOUTH OUACHITA CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 816 BENTON RD | ||||||||
| Address2: | |||||||||
| City: | BOSSIER CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711113744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187478895 | ||||||||
| FaxNumber: | 3187521940 | ||||||||
| Practice Location | |||||||||
| Address1: | 4310 S GRAND ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712026322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186548920 | ||||||||
| FaxNumber: | 3186548921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2018 | ||||||||
| LastUpdateDate: | 08/14/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MEANS | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3187460420 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BASTROP REHABILITATION HOSPITAL, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.