Healthcare Provider Details

I. General information

NPI: 1376511493
Provider Name (Legal Business Name): PROMISE HOSPITAL OF LOUISIANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 IRVING PL
SHREVEPORT LA
71101-4608
US

IV. Provider business mailing address

999 YAMATO ROAD 3RD FLOOR
BOCA RATON FL
33431
US

V. Phone/Fax

Practice location:
  • Phone: 318-425-4096
  • Fax: 318-425-8483
Mailing address:
  • Phone: 561-869-3100
  • Fax: 561-826-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number516
License Number StateLA

VIII. Authorized Official

Name: MR. JAMES HOPWOOD
Title or Position: CFO
Credential:
Phone: 561-869-3100