Healthcare Provider Details

I. General information

NPI: 1003836552
Provider Name (Legal Business Name): PRESTIGE REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64030 HIGHWAY 434 FL 2
LACOMBE LA
70445-3456
US

IV. Provider business mailing address

14500 HAYNE BLVD STE 100
NEW ORLEANS LA
70128-1751
US

V. Phone/Fax

Practice location:
  • Phone: 504-210-3000
  • Fax: 504-210-3006
Mailing address:
  • Phone: 504-210-3000
  • Fax: 504-210-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number412
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY BOHNE
Title or Position: ASSISTANT ADMINISTRATOR
Credential: LICENSED ADMINISTRAT
Phone: 504-210-3000