Healthcare Provider Details

I. General information

NPI: 1063809556
Provider Name (Legal Business Name): MORNING STAR HEALTH REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3173 WASHINGTON AVENUE
BATON ROUGE LA
70802
US

IV. Provider business mailing address

3173 WASHINGTON AVENUE
BATON ROUGE LA
70802
US

V. Phone/Fax

Practice location:
  • Phone: 225-778-7678
  • Fax: 225-341-6825
Mailing address:
  • Phone: 225-778-7678
  • Fax: 225-341-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2203783089
License Number StateLA

VIII. Authorized Official

Name: MRS. CYNTHIA R JACKSON
Title or Position: DIRECTOR/CEO
Credential:
Phone: 225-778-7678