Provider Demographics
NPI:1023279007
Name:PRIORITY HEALTH REHAB
Entity type:Organization
Organization Name:PRIORITY HEALTH REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PTA
Authorized Official - Prefix:MR
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:NAZIR
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-772-3841
Mailing Address - Street 1:37232 AUDUBON PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GEISMAR
Mailing Address - State:LA
Mailing Address - Zip Code:70734-3266
Mailing Address - Country:US
Mailing Address - Phone:225-772-3841
Mailing Address - Fax:225-366-0231
Practice Address - Street 1:37232 AUDUBON PARK AVE
Practice Address - Street 2:
Practice Address - City:GEISMAR
Practice Address - State:LA
Practice Address - Zip Code:70734-3266
Practice Address - Country:US
Practice Address - Phone:225-772-3841
Practice Address - Fax:225-366-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-22
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA4899251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health