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NPI Code Detail

MEDICARE: SPECTRUM REHAB SERVICES, INC.

MEDICARE: SPECTRUM REHAB SERVICES, INC.
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
1251S00000XCommunity/Behavioral Health Agency1548839LA
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356493530
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPECTRUM REHAB SERVICES, INC.
Provider Business Mailing Address
First Line : 30826 LINDER RD
Second Line :
City : DENHAM SPRINGS
State : LA
Zip : 70726-8507
Country : US
Telephone Number : 225-665-7878
Fax Number : 225-665-7856
Provider Business Practice Location Address
First Line : 30826 LINDER RD
Second Line :
City : DENHAM SPRINGS
State : LA
Zip : 70726-8507
Country : US
Telephone Number : 225-665-7878
Fax Number : 225-665-7856
Authorized Official
Title or Position : COO
Name : MR. KYLE JACOB
Credential :
Telephone Number : 318-746-0420
Provider Enumeration Date : 01/17/2007
Last Update Date : 07/24/2023

Similar Medicare Providers

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Practice Location Address:
30826 LINDER RD
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70726-8507
Practice Phone: 225-665-7878
Practice Fax: 225-665-7856
1982811576 — MS. SUMMER R CHAVES MA
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1073782819 — MISS MICHELLE LOUISE MINER LCSW-BACS
Practice Location Address:
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DENHAM SPRINGS, LA
70726-8507
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Practice Fax: 225-665-7856
1457518987 — MS. ASHLEY NICOLE PAUL MSW.RSW
Practice Location Address:
30826 LINDER RD
DENHAM SPRINGS, LA
70726-8507
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Practice Fax: 225-665-7856
1790018364 — MS. KEESHA LACHELLE JAMES MA
Practice Location Address:
30826 LINDER RD
DENHAM SPRINGS, LA
70726-8507
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Practice Fax:
1407225303 — MRS. CYNTHIA BOURGEOIS ABED LCSW-BACS
Practice Location Address:
30826 LINDER RD
DENHAM SPRINGS, LA
70726-8507
Practice Phone: 225-665-7878
Practice Fax: 225-665-7856

Directions to “SPECTRUM REHAB SERVICES, INC. ” Practice Location

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