Healthcare Provider Details

I. General information

NPI: 1972968949
Provider Name (Legal Business Name): EXCEPTIONAL REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8155 JEFFERSON HWY 903
BATON ROUGE LA
70809-1604
US

IV. Provider business mailing address

8155 JEFFERSON HWY 903
BATON ROUGE LA
70809-1604
US

V. Phone/Fax

Practice location:
  • Phone: 225-439-1720
  • Fax:
Mailing address:
  • Phone: 225-439-1720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. DEBRA EACKLES
Title or Position: MANAGER
Credential:
Phone: 225-439-1720