Healthcare Provider Details

I. General information

NPI: 1972669026
Provider Name (Legal Business Name): COMMUNITY REHABILITATION HOSPITAL OF COUSHATTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 RINGGOLD AVE SUITE B
COUSHATTA LA
71019-9073
US

IV. Provider business mailing address

1110 RINGGOLD AVE SUITE B
COUSHATTA LA
71019-9073
US

V. Phone/Fax

Practice location:
  • Phone: 318-932-1770
  • Fax: 318-932-9515
Mailing address:
  • Phone: 318-932-1770
  • Fax: 318-932-9515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number476
License Number StateLA

VIII. Authorized Official

Name: MRS. ALLISON COOPER
Title or Position: ADMINISTRATOR CEO
Credential:
Phone: 318-932-1770