MEDICARE: SC REHAB

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1487291944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SC REHAB

Provider Business Mailing Address
First Line	:	PO BOX 1602
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70470-1602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 FLORIDA AVE SW STE A
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4930
Country	:	US
Telephone Number	:	225-243-5247
Fax Number	:	225-998-1335

Authorized Official
Title or Position	:	OWNER
Name	:	NELSON J CURTIS III
Credential	:	DC
Telephone Number	:	985-893-2223

Provider Enumeration Date	:	12/04/2019
Last Update Date	:	12/04/2019

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