Provider Demographics
NPI:1548492796
Name:ROCKWALL BATON ROUGE REHABILITATION HOSPITAL, LP
Entity type:Organization
Organization Name:ROCKWALL BATON ROUGE REHABILITATION HOSPITAL, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:VICE PRESIDENT
Authorized Official - Phone:972-479-1380
Mailing Address - Street 1:1100 E CAMPBELL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-6708
Mailing Address - Country:US
Mailing Address - Phone:972-479-1380
Mailing Address - Fax:
Practice Address - Street 1:8000 SUMMA AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3423
Practice Address - Country:US
Practice Address - Phone:225-819-0703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA653314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA653OtherLA LICENSE
LA195621Medicare Oscar/Certification