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General NPI Number Information
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NPI Number | 1174238737
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Entity Type | Organization
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Legal Business Name | SPECIALTY EXTENDED CARE HOSPITAL OF MONROE LLC
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Dates
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Enumeration Date | 01/18/2023
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 309 JACKSON ST FL 3
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City | MONROE
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State | LA
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Zip | 71201-7407
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Country | US
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Telephone | 318-966-4126
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 51266
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City | LAFAYETTE
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State | LA
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Zip | 70505-1266
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Country | US
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Telephone | 337-233-1307
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Fax |
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Authorized Official
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Title or Position | EVP/SECRETARY
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Name | NICHOLAS GACHASSIN III
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Credential |
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Telephone | 337-233-1307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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