Healthcare Provider Details

I. General information

NPI: 1588899009
Provider Name (Legal Business Name): LTAC HOSPITAL OF WASHINGTON- ST. TAMMANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 COLUMBIA ST
BOGALUSA LA
70427-4721
US

IV. Provider business mailing address

101 LA RUE FRANCE SUITE 500
LAFAYETTE LA
70508-3144
US

V. Phone/Fax

Practice location:
  • Phone: 985-732-4402
  • Fax: 985-732-4708
Mailing address:
  • Phone: 337-269-9828
  • Fax: 337-234-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number584
License Number StateLA

VIII. Authorized Official

Name: DAWN D. HARGRAVE
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 337-269-9828