MEDICARE: BASTROP 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	432	LA

General Provider Information

NPI Number	:	1851619241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASTROP REHABILITATION HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	816 BENTON RD
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3744
Country	:	US
Telephone Number	:	318-742-3408
Fax Number	:	318-752-1940

Provider Business Practice Location Address
First Line	:	4310 S GRAND ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-6322
Country	:	US
Telephone Number	:	318-654-8300
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. WILLIAM H. MEANS JR.
Credential	:
Telephone Number	:	318-422-1640

Provider Enumeration Date	:	05/10/2010
Last Update Date	:	11/05/2019

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