Healthcare Provider Details

I. General information

NPI: 1275608267
Provider Name (Legal Business Name): RUSTON NURSING AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 HIGHWAY 80
RUSTON LA
71270-8943
US

IV. Provider business mailing address

PO BOX 428
ORCHARD PARK NY
14127-0428
US

V. Phone/Fax

Practice location:
  • Phone: 318-255-5001
  • Fax: 318-254-1387
Mailing address:
  • Phone: 716-662-4955
  • Fax: 716-667-9230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number901
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1522121
Identifier TypeMEDICAID
Identifier StateLA
Identifier Issuer

VIII. Authorized Official

Name: MR. NORBERT A BENNETT
Title or Position: CO-CHIEF EXECUTIVE OFFICER
Credential:
Phone: 716-662-4955