Healthcare Provider Details

I. General information

NPI: 1508301912
Provider Name (Legal Business Name): REHABILITATION SERVICES OF LOUISIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 WEST ST
WINNSBORO LA
71295-3842
US

IV. Provider business mailing address

816 BENTON RD
BOSSIER CITY LA
71111-3744
US

V. Phone/Fax

Practice location:
  • Phone: 318-435-4651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER QUENTIN MUDD
Title or Position: CEO
Credential: MPA
Phone: 318-742-3408