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NPI Code Detail

MEDICARE: RIVERSIDE HOSPITAL OF LOUISIANA, INC.

MEDICARE: RIVERSIDE HOSPITAL OF LOUISIANA, 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
1273Y00000XRehabilitation Hospital Unit
2282E00000XLong Term Care Hospital

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
160554OTHERBLUE CROSS

General Provider Information

NPI Number : 1629039193
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVERSIDE HOSPITAL OF LOUISIANA, INC.
Provider Business Mailing Address
First Line : 1000 CHINABERRY DR STE 200
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-2443
Country : US
Telephone Number : 318-684-6050
Fax Number : 318-684-6051
Provider Business Practice Location Address
First Line : 13 HEYMAN LN
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71303-3574
Country : US
Telephone Number : 318-767-2900
Fax Number : 318-442-4505
Authorized Official
Title or Position : GROUP PRESIDENT
Name : MR. WADE LESTER
Credential :
Telephone Number : 318-684-6050
Provider Enumeration Date : 03/31/2006
Last Update Date : 10/03/2025

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Directions to “RIVERSIDE HOSPITAL OF LOUISIANA, INC. ” Practice Location

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