Provider Demographics
NPI:1538402748
Name:NEW LIFECARE SPECIALTY HOSPITAL OF NORTH LOUISIANA LLC
Entity type:Organization
Organization Name:NEW LIFECARE SPECIALTY HOSPITAL OF NORTH LOUISIANA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-658-9977
Mailing Address - Street 1:1000 CHINABERRY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2443
Mailing Address - Country:US
Mailing Address - Phone:318-658-9977
Mailing Address - Fax:318-658-9979
Practice Address - Street 1:1401 EZELLE ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-7218
Practice Address - Country:US
Practice Address - Phone:318-251-3126
Practice Address - Fax:318-251-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203781834282N00000X
LA699282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA192022Medicare Oscar/Certification