Healthcare Provider Details

I. General information

NPI: 1992718605
Provider Name (Legal Business Name): HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 01/26/2020
Certification Date: 01/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 MAIN STREET
ZACHARY LA
70791-4099
US

IV. Provider business mailing address

6300 MAIN STREET
ZACHARY LA
70791-4099
US

V. Phone/Fax

Practice location:
  • Phone: 225-658-4300
  • Fax:
Mailing address:
  • Phone: 225-658-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PHIL HACKER
Title or Position: PFS DIRECTOR
Credential:
Phone: 225-658-4505