Basic Information
| Provider Information | |||||||||
| NPI: | 1891018826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHAB SERVICES OF NE LA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 816 BENTON RD | ||||||||
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| City: | BOSSIER CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711113744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187423408 | ||||||||
| FaxNumber: | 3187521940 | ||||||||
| Practice Location | |||||||||
| Address1: | 4327 STERLINGTON RD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712032337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183245441 | ||||||||
| FaxNumber: | 3183245442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2010 | ||||||||
| LastUpdateDate: | 03/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | ST. AMANT | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3182088709 | ||||||||
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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 | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.