Basic Information
| Provider Information | |||||||||
| NPI: | 1962676874 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLEGIANCE HOSPITAL OF MANY,LLC | ||||||||
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| OtherOrganizationName: | ZWOLLE EXPRESS CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 HIGHLAND DR | ||||||||
| Address2: | SABINE MEDICAL CENTER | ||||||||
| City: | MANY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714493718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182561232 | ||||||||
| FaxNumber: | 3182561298 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 OBRIE ST | ||||||||
| Address2: | |||||||||
| City: | ZWOLLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714862510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186456168 | ||||||||
| FaxNumber: | 3186456168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2008 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BORDELON | ||||||||
| AuthorizedOfficialFirstName: | ROCK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3182268202 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 643 | LA | N | Hospitals | General Acute Care Hospital | 261QR1300X | 643RHC2 | LA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 1037605 | 05 | LA | MEDICAID |