MEDICARE: PREMIER 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306846050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER REHABILITATION HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	4310 S GRAND ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-6322
Country	:	US
Telephone Number	:	318-812-1000
Fax Number	:	318-812-1012

Provider Business Practice Location Address
First Line	:	4310 S GRAND ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-6322
Country	:	US
Telephone Number	:	318-812-1000
Fax Number	:	318-812-1012

Authorized Official
Title or Position	:	CFO
Name	:	MR. SCOTT MARKSTROM
Credential	:
Telephone Number	:	337-993-5711

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	08/22/2020

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