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NPI Code Detail

MEDICARE: REHABILITATION SERVICES OF NORTHWEST LOUISIANA, LLC

MEDICARE: REHABILITATION SERVICES OF NORTHWEST LOUISIANA, 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
1251S00000XCommunity/Behavioral Health Agency
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)1151254LA

General Provider Information

NPI Number : 1427137074
Entity Type Code : Organization
Provider Name (Legal Business Name) : REHABILITATION SERVICES OF NORTHWEST LOUISIANA, LLC
Provider Business Mailing Address
First Line : 1000 CHINABERRY DR STE 900
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-2455
Country : US
Telephone Number : 318-746-0420
Fax Number : 318-626-5429
Provider Business Practice Location Address
First Line : 1301 YOUREE DR
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-5117
Country : US
Telephone Number : 318-675-0804
Fax Number : 318-425-9030
Authorized Official
Title or Position : OWNER/OPERATOR
Name : MATTHEW ST. AMANT
Credential :
Telephone Number : 318-675-0804
Provider Enumeration Date : 11/03/2006
Last Update Date : 06/19/2023

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