Provider Demographics
NPI:1902137946
Name:MERRYVILLE REHABILITATION LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:MERRYVILLE REHABILITATION LIMITED PARTNERSHIP
Other - Org Name:MERRYVILLE REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAWNE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-812-2140
Mailing Address - Street 1:101 N 2ND ST # 200
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-3266
Mailing Address - Country:US
Mailing Address - Phone:318-812-2140
Mailing Address - Fax:318-812-2143
Practice Address - Street 1:900 N BRYAN ST
Practice Address - Street 2:
Practice Address - City:MERRYVILLE
Practice Address - State:LA
Practice Address - Zip Code:70653-3302
Practice Address - Country:US
Practice Address - Phone:337-825-6181
Practice Address - Fax:337-825-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA881314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1510025Medicaid
LA195451Medicare Oscar/Certification