Healthcare Provider Details

I. General information

NPI: 1538402748
Provider Name (Legal Business Name): NEW LIFECARE SPECIALTY HOSPITAL OF NORTH LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 EZELLE ST
RUSTON LA
71270-7218
US

IV. Provider business mailing address

1000 CHINABERRY DR STE 200
BOSSIER CITY LA
71111-2443
US

V. Phone/Fax

Practice location:
  • Phone: 318-251-3126
  • Fax: 318-251-1594
Mailing address:
  • Phone: 318-658-9977
  • Fax: 318-658-9979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number699
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2203781834
License Number StateLA

VIII. Authorized Official

Name: SUZIE GRAS
Title or Position: BILLING OFFICE MANAGER
Credential:
Phone: 318-658-9977