Provider Demographics
NPI:1174720163
Name:ADVANTAGE REHABILITATION AND HAND SPECIALTY CENTER
Entity type:Organization
Organization Name:ADVANTAGE REHABILITATION AND HAND SPECIALTY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:
Authorized Official - Last Name:REES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-818-1365
Mailing Address - Street 1:PO BOX 23417
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70183-0417
Mailing Address - Country:US
Mailing Address - Phone:504-818-1365
Mailing Address - Fax:
Practice Address - Street 1:151 MEADOWCREST ST
Practice Address - Street 2:SUITE E
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5256
Practice Address - Country:US
Practice Address - Phone:504-392-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CM80Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER