MEDICARE: NEW IBERIA REHABILITATION HOSPITAL LLC

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	283X00000X	Rehabilitation Hospital

General Provider Information

NPI Number	:	1649503103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW IBERIA REHABILITATION HOSPITAL LLC

Provider Business Mailing Address
First Line	:	532 JEFFERSON TERRACE STREET
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70560-4948
Country	:	US
Telephone Number	:	337-364-6923
Fax Number	:	337-608-0362

Provider Business Practice Location Address
First Line	:	532 JEFFERSON TERRACE STREET
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70560-4948
Country	:	US
Telephone Number	:	337-364-6923
Fax Number	:	337-608-0362

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ATHAN J. OLIVIER III
Credential	:
Telephone Number	:	337-364-6923

Provider Enumeration Date	:	09/15/2009
Last Update Date	:	09/15/2009

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