Healthcare Provider Details

I. General information

NPI: 1083162465
Provider Name (Legal Business Name): REHABILITATION SERVICES OF CENTRAL LOUISIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 DIXIE PLAZA
NATCHITOCHES LA
71457-5737
US

IV. Provider business mailing address

1000 CHINABERRY DR STE 900
BOSSIER CITY LA
71111-2455
US

V. Phone/Fax

Practice location:
  • Phone: 318-357-9009
  • Fax:
Mailing address:
  • Phone: 318-746-0420
  • Fax: 318-626-5429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KYLE JACOB
Title or Position: COO
Credential:
Phone: 318-746-0420