Healthcare Provider Details

I. General information

NPI: 1770368920
Provider Name (Legal Business Name): CLHG-RUSTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 S FARMERVILLE ST
RUSTON LA
71270-5914
US

IV. Provider business mailing address

1118 S FARMERVILLE ST
RUSTON LA
71270-5914
US

V. Phone/Fax

Practice location:
  • Phone: 318-254-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: KATHY M HALL
Title or Position: CEO
Credential:
Phone: 318-254-2450