Healthcare Provider Details

I. General information

NPI: 1275622615
Provider Name (Legal Business Name): PHC-OPELOUSAS LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3983 I 49 S SERVICE RD
OPELOUSAS LA
70570-0758
US

IV. Provider business mailing address

103 POWELL CT STE. 200
BRENTWOOD TN
37027-5079
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-2100
  • Fax: 337-948-2173
Mailing address:
  • Phone: 615-372-8500
  • Fax: 615-372-8572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM M. GRACEY
Title or Position: COO
Credential:
Phone: 615-372-8500