Provider Demographics
NPI:1487103180
Name:LOUISIANA CARDIAC REHAB, LLC
Entity type:Organization
Organization Name:LOUISIANA CARDIAC REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:504-861-9981
Mailing Address - Street 1:138 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5620
Mailing Address - Country:US
Mailing Address - Phone:504-861-9981
Mailing Address - Fax:504-861-9704
Practice Address - Street 1:2000 CANAL ST
Practice Address - Street 2:CARDIOLOGY DEPARTMENT
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-861-9981
Practice Address - Fax:504-861-9704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities