Healthcare Provider Details

I. General information

NPI: 1790850378
Provider Name (Legal Business Name): GULF STATES LONG TERM ACUTE CARE OF NEW ORLEANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W ESPLANADE AVE FIFTH FLOOR
KENNER LA
70065-2467
US

IV. Provider business mailing address

PO BOX 641600
KENNER LA
70064-1600
US

V. Phone/Fax

Practice location:
  • Phone: 504-464-8590
  • Fax: 504-464-8550
Mailing address:
  • Phone: 504-464-8590
  • Fax: 504-464-8550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number625
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number625
License Number StateLA

VIII. Authorized Official

Name: MR. EUGENE E. SMITH
Title or Position: PRESIDENT
Credential:
Phone: 225-216-2299