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General NPI Number Information
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NPI Number | 1427343607
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Entity Type | Organization
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Legal Business Name | LOUISIANA REENTRY & REHABILITATION SERVICES INC.
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 1116 JACKSON ST
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City | MONROE
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State | LA
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Zip | 71202-2024
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Country | US
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Telephone | 318-325-1506
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Fax | 318-325-1585
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Provider Business Mailing Address
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Address Line | 1116 JACKSON ST
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City | MONROE
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State | LA
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Zip | 71202-2024
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Country | US
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Telephone | 318-325-1506
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Fax | 318-325-1585
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES R THEUS
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Credential |
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Telephone | 318-614-1598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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