Healthcare Provider Details

I. General information

NPI: 1770397002
Provider Name (Legal Business Name): NEULIFE REHABILITATION OF LOUISIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41238 ADAMS RD
HAMMOND LA
70403-2069
US

IV. Provider business mailing address

189 ADAM SHEPHERD PARKWAY, SUITE 17 PMB #280
SHEPHERDSVILLE KY
40165
US

V. Phone/Fax

Practice location:
  • Phone: 502-558-8312
  • Fax: 502-215-6877
Mailing address:
  • Phone: 502-558-8312
  • Fax: 502-215-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: PATRICK G KELLEY
Title or Position: CEO
Credential:
Phone: 502-558-8312