Healthcare Provider Details

I. General information

NPI: 1356493530
Provider Name (Legal Business Name): SPECTRUM REHAB SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30826 LINDER RD
DENHAM SPRINGS LA
70726-8507
US

IV. Provider business mailing address

30826 LINDER RD
DENHAM SPRINGS LA
70726-8507
US

V. Phone/Fax

Practice location:
  • Phone: 225-665-7878
  • Fax: 225-665-7856
Mailing address:
  • Phone: 225-665-7878
  • Fax: 225-665-7856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1548839
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. KYLE JACOB
Title or Position: COO
Credential:
Phone: 318-746-0420