Healthcare Provider Details

I. General information

NPI: 1578702288
Provider Name (Legal Business Name): GENESIS SPECIALTY HOSPITALS II,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 COMMERCE ST STE B
GRETNA LA
70056
US

IV. Provider business mailing address

3918 JACKSON STREET EXT
ALEXANDRIA LA
71303-3007
US

V. Phone/Fax

Practice location:
  • Phone: 504-391-1500
  • Fax: 504-391-1501
Mailing address:
  • Phone: 318-445-7344
  • Fax: 318-484-2865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number624
License Number StateLA

VIII. Authorized Official

Name: MRS. SISSY BRUCE
Title or Position: BILLER
Credential:
Phone: 318-445-7344