Healthcare Provider Details

I. General information

NPI: 1104980473
Provider Name (Legal Business Name): AMERICAN LEGION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S BRADFORD ST
RAYNE LA
70578-6961
US

IV. Provider business mailing address

1305 CROWLEY RAYNE HWY
CROWLEY LA
70526-8202
US

V. Phone/Fax

Practice location:
  • Phone: 337-783-3222
  • Fax: 337-788-6598
Mailing address:
  • Phone: 337-783-3222
  • Fax: 337-788-6598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number242-A
License Number StateLA

VIII. Authorized Official

Name: CHARMAINE VIDRINE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 337-783-3222