Healthcare Provider Details

I. General information

NPI: 1760961338
Provider Name (Legal Business Name): BASTROP REHABILITATION HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 S GRAND ST STE 1
MONROE LA
71202-6322
US

IV. Provider business mailing address

816 BENTON RD
BOSSIER CITY LA
71111-3744
US

V. Phone/Fax

Practice location:
  • Phone: 318-654-8920
  • Fax: 318-654-8921
Mailing address:
  • Phone: 318-747-8895
  • Fax: 318-752-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MEANS
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-746-0420