Healthcare Provider Details

I. General information

NPI: 1013166388
Provider Name (Legal Business Name): HIGH HOPE REHABILITATION AND NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 HIGH HOPE RD
SULPHUR LA
70663-0037
US

IV. Provider business mailing address

475 HIGH HOPE RD
SULPHUR LA
70663-0037
US

V. Phone/Fax

Practice location:
  • Phone: 337-527-8140
  • Fax: 337-527-0098
Mailing address:
  • Phone: 337-527-8140
  • Fax: 337-527-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number687
License Number StateLA

VIII. Authorized Official

Name: KENDALL A BROUSSARD
Title or Position: MANAGING MEMBER
Credential:
Phone: 337-439-6600