Healthcare Provider Details

I. General information

NPI: 1285649939
Provider Name (Legal Business Name): ST THERESA HOSPITAL OF KENNER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 LOYOLA DRIVE
KENNER LA
70065-1797
US

IV. Provider business mailing address

3900 VETERANS BLVS THIRD FLOOR
METAIRIE LA
70002-5364
US

V. Phone/Fax

Practice location:
  • Phone: 504-468-8552
  • Fax: 504-885-3600
Mailing address:
  • Phone: 504-885-3900
  • Fax: 504-885-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOHN A LILJEBERG JR.
Title or Position: OWNER DIRECTOR
Credential: R PH
Phone: 504-885-3900