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General NPI Number Information
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NPI Number | 1538438015
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Entity Type | Organization
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Legal Business Name | TASS BRAIN INJURY REHABILITATION CENTER
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Dates
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Enumeration Date | 12/29/2011
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 42215 PLEASANT RG EXT
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City | PONCHATOULA
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State | LA
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Zip | 70454-4723
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Country | US
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Telephone | 985-370-0323
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Fax | 985-370-0324
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Provider Business Mailing Address
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Address Line | 42215 PLEASANT RG EXT
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City | PONCHATOULA
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State | LA
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Zip | 70454-4723
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Country | US
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Telephone | 985-370-0323
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Fax | 985-370-0324
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | SUZANNE LENTZ
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Credential |
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Telephone | 985-370-0323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 005
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License Number State | LA
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