MEDICARE: NEW LIFE REHABILITATION OF SHREVEPORT, 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
1	283X00000X	Rehabilitation Hospital

General Provider Information

NPI Number	:	1760522130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE REHABILITATION OF SHREVEPORT, LLC

Provider Business Mailing Address
First Line	:	2140 MIDWAY ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-2206
Country	:	US
Telephone Number	:	318-631-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 MIDWAY ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-2206
Country	:	US
Telephone Number	:	318-631-2345
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MARC PEARCE
Credential	:
Telephone Number	:	318-631-2345

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/22/2020

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