Provider Demographics
NPI:1306167275
Name:IBERVILLE CARDIAC REHAB INC
Entity type:Organization
Organization Name:IBERVILLE CARDIAC REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:GIZZELA
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:504-812-2455
Mailing Address - Street 1:59350 RIVER WEST DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-6553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:59350 RIVER WEST DR
Practice Address - Street 2:SUITE 104
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-6553
Practice Address - Country:US
Practice Address - Phone:504-812-2455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities