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General NPI Number Information
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NPI Number | 1003836552
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Entity Type | Organization
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Legal Business Name | PRESTIGE REHAB
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 64030 HIGHWAY 434 FL 2
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City | LACOMBE
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State | LA
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Zip | 70445-3456
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Country | US
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Telephone | 504-210-3000
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Fax | 504-210-3006
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Provider Business Mailing Address
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Address Line | 14500 HAYNE BLVD STE 100
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City | NEW ORLEANS
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State | LA
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Zip | 70128-1751
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Country | US
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Telephone | 504-210-3000
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Fax | 504-210-3006
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Authorized Official
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Title or Position | ASSISTANT ADMINISTRATOR
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Name | MRS. KIMBERLY BOHNE
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Credential | LICENSED ADMINISTRAT
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Telephone | 504-210-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | 412
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number |
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License Number State |
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