Healthcare Provider Details

I. General information

NPI: 1902137946
Provider Name (Legal Business Name): MERRYVILLE REHABILITATION LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N BRYAN ST
MERRYVILLE LA
70653-3302
US

IV. Provider business mailing address

101 N 2ND ST # 200
WEST MONROE LA
71291-3266
US

V. Phone/Fax

Practice location:
  • Phone: 337-825-6181
  • Fax: 337-825-6176
Mailing address:
  • Phone: 318-812-2140
  • Fax: 318-812-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number881
License Number StateLA

VIII. Authorized Official

Name: DAWNE RENEE SMITH
Title or Position: CEO
Credential:
Phone: 318-812-2140