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General NPI Number Information
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NPI Number | 1588877567
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Entity Type | Organization
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Legal Business Name | UNIVERSAL REHABILITATION CENTER, LLC
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 2414 FERRAND ST STE 2
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City | MONROE
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State | LA
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Zip | 71201-3255
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Country | US
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Telephone | 318-342-9979
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Fax | 318-325-0070
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Provider Business Mailing Address
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Address Line | 2414 FERRAND ST STE 2
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City | MONROE
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State | LA
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Zip | 71201-3255
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Country | US
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Telephone | 318-342-9979
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Fax | 318-325-0070
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MRS. TIFFANY RENE' WYATT
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Credential | MBA
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Telephone | 318-342-9979
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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 | ADC 10106
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License Number State | LA
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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 |
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License Number State |
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