Provider Demographics
NPI:1154790327
Name:BOGALUSA REHABILITATION HOSPITAL LLC
Entity type:Organization
Organization Name:BOGALUSA REHABILITATION HOSPITAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-254-4535
Mailing Address - Street 1:621 S. COLUMBIA STREET
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-4721
Mailing Address - Country:US
Mailing Address - Phone:337-254-4535
Mailing Address - Fax:337-269-5506
Practice Address - Street 1:621 S. COLUMBIA STREET
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-4721
Practice Address - Country:US
Practice Address - Phone:337-254-4535
Practice Address - Fax:337-269-5506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital