Healthcare Provider Details

I. General information

NPI: 1003920414
Provider Name (Legal Business Name): BAYOU RAPIDES REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 BAYOU RAPIDES RD
ALEXANDRIA LA
71303-3653
US

IV. Provider business mailing address

PO BOX 12368
ALEXANDRIA LA
71315-2368
US

V. Phone/Fax

Practice location:
  • Phone: 318-561-2010
  • Fax: 318-561-0098
Mailing address:
  • Phone: 318-561-2010
  • Fax: 318-561-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JODIE LINCOLN ROBERTS II
Title or Position: DIRECTOR
Credential: M.S.
Phone: 318-561-2010