Healthcare Provider Details

I. General information

NPI: 1437346186
Provider Name (Legal Business Name): SPECIALTY REHABILITATION HOSPITAL, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 RINGGOLD AVENUE SUITE B
COUSHATTA LA
71019
US

IV. Provider business mailing address

P.O. BOX 309
COUSHATTA LA
71019
US

V. Phone/Fax

Practice location:
  • Phone: 318-932-1770
  • Fax: 318-932-1772
Mailing address:
  • Phone: 318-932-1770
  • Fax: 318-932-1772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number630
License Number StateLA

VIII. Authorized Official

Name: MR. PHILLIP CRAIG BALL
Title or Position: GOVERNING BOARD CHAIRMAN / CEO
Credential:
Phone: 337-238-4449