Provider Demographics
NPI:1366751182
Name:LOUISIANA HEALTH & REHABILITATION COPTIONS
Entity type:Organization
Organization Name:LOUISIANA HEALTH & REHABILITATION COPTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SOUNDRA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:TEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-231-2490
Mailing Address - Street 1:214 OCEAN DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4618
Mailing Address - Country:US
Mailing Address - Phone:225-231-2490
Mailing Address - Fax:225-231-2857
Practice Address - Street 1:800 E VERMILION ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-8148
Practice Address - Country:US
Practice Address - Phone:337-261-4900
Practice Address - Fax:337-267-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAADC 081310251C00000X, 251S00000X, 261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1171727Medicaid
LA1954748Medicaid
LA1177482Medicaid
LA1453773Medicaid
LA1453781Medicaid
LA1653187Medicaid