Provider Demographics
NPI:1255535530
Name:HANNIE REHAB L.L.C
Entity type:Organization
Organization Name:HANNIE REHAB L.L.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICOL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HANNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-981-0333
Mailing Address - Street 1:203 RUE FOUNTAINE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5775
Mailing Address - Country:US
Mailing Address - Phone:337-981-0333
Mailing Address - Fax:337-988-1706
Practice Address - Street 1:203 RUE FOUNTAINE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5775
Practice Address - Country:US
Practice Address - Phone:337-981-0333
Practice Address - Fax:337-988-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities