MEDICARE: HALCYON REHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	A8334	LA

General Provider Information

NPI Number	:	1558726828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALCYON REHAB

Provider Business Mailing Address
First Line	:	36020 WILMINGTON AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70706-1523
Country	:	US
Telephone Number	:	504-287-6802
Fax Number	:

Provider Business Practice Location Address
First Line	:	36020 WILMINGTON AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70706-1523
Country	:	US
Telephone Number	:	504-287-6802
Fax Number	:

Authorized Official
Title or Position	:	PTA
Name	:	JOSEPH JOHN BROGGI
Credential	:
Telephone Number	:	504-287-6802

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	12/30/2015

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Directions to “HALCYON REHAB ” Practice Location

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