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General NPI Number Information
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NPI Number | 1073818399
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Entity Type | Organization
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Legal Business Name | PREMIER REHAB
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 1125 PAUL MAILLARD RD
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City | LULING
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State | LA
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Zip | 70070-4351
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Country | US
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Telephone | 985-785-8271
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Fax | 985-785-9944
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Provider Business Mailing Address
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Address Line | 211 E WORTHY ST BUILDING 4
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City | GONZALES
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State | LA
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Zip | 70737-4232
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Country | US
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Telephone | 225-644-7044
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Fax | 225-644-4414
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Authorized Official
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Title or Position | CEO
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Name | BRIDGET REDMOND
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Credential |
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Telephone | 225-644-7044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 1841
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License Number State | LA
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