Healthcare Provider Details

I. General information

NPI: 1285638155
Provider Name (Legal Business Name): LAKEWOOD QUARTERS REHAB 8225 TENANT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8225 SUMMA AVE
BATON ROUGE LA
70809-3422
US

IV. Provider business mailing address

8225 SUMMA AVE
BATON ROUGE LA
70809-3422
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-0130
  • Fax: 225-766-0145
Mailing address:
  • Phone: 225-766-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number726
License Number StateLA

VIII. Authorized Official

Name: MR. ALEX PALEY
Title or Position: COO
Credential:
Phone: 914-390-4363