Provider Demographics
NPI:1215197181
Name:SOUTHERN REGIONAL HEALTHCARE GROUP, LLC
Entity type:Organization
Organization Name:SOUTHERN REGIONAL HEALTHCARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERITA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NARCISSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-342-2319
Mailing Address - Street 1:425 W BERARD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582-3201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1305 CROWLEY RAYNE HWY
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-8202
Practice Address - Country:US
Practice Address - Phone:337-342-2319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital