Provider Demographics
NPI:1386620045
Name:IBERIA REHABILITATION HOSPITAL, LLC
Entity type:Organization
Organization Name:IBERIA REHABILITATION HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-216-2299
Mailing Address - Street 1:532 JEFFERSON TER
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4948
Mailing Address - Country:US
Mailing Address - Phone:337-364-6923
Mailing Address - Fax:337-364-6924
Practice Address - Street 1:532 JEFFERSON TERRRACE
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4948
Practice Address - Country:US
Practice Address - Phone:337-364-6923
Practice Address - Fax:337-364-6924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA561283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1710822Medicaid
LA61348OtherBCBS
LA61348OtherBCBS