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General NPI Number Information
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NPI Number | 1427137074
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Entity Type | Organization
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Legal Business Name | REHABILITATION SERVICES OF NORTHWEST LOUISIANA, LLC
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 1301 YOUREE DR
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City | SHREVEPORT
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State | LA
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Zip | 71101-5117
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Country | US
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Telephone | 318-675-0804
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Fax | 318-425-9030
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Provider Business Mailing Address
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Address Line | 1000 CHINABERRY DR STE 900
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City | BOSSIER CITY
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State | LA
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Zip | 71111-2455
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Country | US
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Telephone | 318-746-0420
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Fax | 318-626-5429
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MATTHEW ST. AMANT
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Credential |
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Telephone | 318-675-0804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 1151254
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License Number State | LA
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