Healthcare Provider Details

I. General information

NPI: 1609891118
Provider Name (Legal Business Name): ST CHARLES SPECIALTY REHABILITATION HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8375 FLORIDA BLVD SUITE B
DENHAM SPRINGS LA
70726-7806
US

IV. Provider business mailing address

210 BARONNE ST APT 716
NEW ORLEANS LA
70112-1745
US

V. Phone/Fax

Practice location:
  • Phone: 225-665-7100
  • Fax: 225-665-7105
Mailing address:
  • Phone: 470-626-3295
  • Fax: 225-224-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number439
License Number StateLA

VIII. Authorized Official

Name: DR. JUANITA BATES BONDS
Title or Position: ADMINISTRATOR
Credential:
Phone: 470-626-3295