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General NPI Number Information
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NPI Number | 1508301912
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Entity Type | Organization
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Legal Business Name | REHABILITATION SERVICES OF LOUISIANA, LLC
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 2401 WEST ST
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City | WINNSBORO
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State | LA
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Zip | 71295-3842
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Country | US
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Telephone | 318-435-4651
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Fax |
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Provider Business Mailing Address
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Address Line | 816 BENTON RD
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City | BOSSIER CITY
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State | LA
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Zip | 71111-3744
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRISTOPHER QUENTIN MUDD
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Credential | MPA
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Telephone | 318-742-3408
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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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