Healthcare Provider Details

I. General information

NPI: 1417930751
Provider Name (Legal Business Name): PAM II OF COVINGTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20050 CRESTWOOD BLVD
COVINGTON LA
70433-5207
US

IV. Provider business mailing address

1828 GOOD HOPE RD SUITE 102
ENOLA PA
17025-1233
US

V. Phone/Fax

Practice location:
  • Phone: 985-902-8148
  • Fax:
Mailing address:
  • Phone: 717-731-9660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number680
License Number StateLA

VIII. Authorized Official

Name: MR. KARICK STOBER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 717-731-9660