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General NPI Number Information
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NPI Number | 1760961338
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Entity Type | Organization
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Legal Business Name | BASTROP REHABILITATION HOSPITAL, LLC
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 4310 S GRAND ST STE 1
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City | MONROE
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State | LA
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Zip | 71202-6322
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Country | US
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Telephone | 318-654-8920
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Fax | 318-654-8921
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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 | 318-747-8895
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Fax | 318-752-1940
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | WILLIAM MEANS
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Credential |
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Telephone | 318-746-0420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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