Healthcare Provider Details

I. General information

NPI: 1770522575
Provider Name (Legal Business Name): ST. JOHN'S SPECIALTY HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 FOLSE ST
HARAHAN LA
70123-3671
US

IV. Provider business mailing address

405 FOLSE ST
HARAHAN LA
70123-3671
US

V. Phone/Fax

Practice location:
  • Phone: 504-738-3339
  • Fax: 504-739-9202
Mailing address:
  • Phone: 504-738-3339
  • Fax: 504-739-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number442
License Number StateLA

VIII. Authorized Official

Name: MR. DEAN DRANGUET
Title or Position: OFFICE MANAGER
Credential:
Phone: 601-853-2667