Healthcare Provider Details

I. General information

NPI: 1205075181
Provider Name (Legal Business Name): LTAC OF LOUISIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 AMBASSADOR CAFFERY PKWY FL 4
LAFAYETTE LA
70508-7265
US

IV. Provider business mailing address

101 LA RUE FRANCE STE 100
LAFAYETTE LA
70508-3138
US

V. Phone/Fax

Practice location:
  • Phone: 337-456-8201
  • Fax: 337-456-8202
Mailing address:
  • Phone: 337-269-9566
  • Fax: 337-269-9823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. JESSICA L MCGEE
Title or Position: CFO
Credential: MBA
Phone: 337-269-9828