Healthcare Provider Details

I. General information

NPI: 1396745246
Provider Name (Legal Business Name): ST. THERESA SPECIALTY HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 HOUMA BLVD 5TH FLOOR
METAIRIE LA
70006-2970
US

IV. Provider business mailing address

3900 VETERANS BLVD. THIRD FLOOR
METAIRIE LA
70002-5634
US

V. Phone/Fax

Practice location:
  • Phone: 504-885-3900
  • 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 Code282E00000X
TaxonomyLong Term Care Hospital
License Number635
License Number StateLA

VIII. Authorized Official

Name: MR. GEOFFREY B. MORRIS
Title or Position: CFO
Credential: CPA
Phone: 504-885-3900