MEDICARE: LOUISIANA REENTRY & REHABILITATION 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
1	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	STATE LICENSE NUMBER	OTHER	LA	STATE LICENSE NUMBER 331

General Provider Information

NPI Number	:	1427343607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISIANA REENTRY & REHABILITATION SERVICES INC.

Provider Business Mailing Address
First Line	:	1116 JACKSON ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-2024
Country	:	US
Telephone Number	:	318-325-1506
Fax Number	:	318-325-1585

Provider Business Practice Location Address
First Line	:	1116 JACKSON ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-2024
Country	:	US
Telephone Number	:	318-325-1506
Fax Number	:	318-325-1585

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHARLES R THEUS
Credential	:
Telephone Number	:	318-614-1598

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	06/15/2011

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