MEDICARE: ACADIA REHABILITATION HOSPITAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	283X00000X	Rehabilitation Hospital	HO0004069	LA
2	283X00000X	Rehabilitation Hospital	452	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60230	OTHER	LA	BLUE CROSS OF LA. PROVIDE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043216583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADIA REHABILITATION HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	ONE HOSPITAL DRIVE
Second Line	:	SUITE 101
City	:	JENNINGS
State	:	LA
Zip	:	70546-3641
Country	:	US
Telephone Number	:	337-821-5353
Fax Number	:	337-821-5366

Provider Business Practice Location Address
First Line	:	ONE HOSPITAL DRIVE
Second Line	:	SUITE 101
City	:	JENNINGS
State	:	LA
Zip	:	70546-3641
Country	:	US
Telephone Number	:	337-821-5353
Fax Number	:	337-821-5366

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL R. HOLLAND
Credential	:	M.D.
Telephone Number	:	337-824-3819

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	11/09/2011

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