Healthcare Provider Details

I. General information

NPI: 1083184642
Provider Name (Legal Business Name): RUSTON REGIONAL REHABILITATION HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
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. SUITE 200
BOSSIER CITY LA
71111-2443
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER K WRIGHT
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 318-658-9977