Healthcare Provider Details

I. General information

NPI: 1851619241
Provider Name (Legal Business Name): BASTROP REHABILITATION HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 S GRAND ST
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: 318-654-8300
  • Fax:
Mailing address:
  • Phone: 318-742-3408
  • Fax: 318-752-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number432
License Number StateLA

VIII. Authorized Official

Name: MR. WILLIAM H. MEANS JR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-422-1640