Provider Demographics
NPI:1366577546
Name:ACTION REHAB AND SUPPLY, INC.
Entity type:Organization
Organization Name:ACTION REHAB AND SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-214-1260
Mailing Address - Street 1:1443 DELPLAZA DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4167
Mailing Address - Country:US
Mailing Address - Phone:225-214-1260
Mailing Address - Fax:225-214-1263
Practice Address - Street 1:1443 DELPLAZA DR
Practice Address - Street 2:SUITE 6
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4167
Practice Address - Country:US
Practice Address - Phone:225-214-1260
Practice Address - Fax:225-214-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1439185Medicaid
LA1439185Medicaid