Provider Demographics
NPI:1427055193
Name:RED RIVER REHAB, LLC
Entity type:Organization
Organization Name:RED RIVER REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:CLAIBORNE
Authorized Official - Last Name:LANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-446-6169
Mailing Address - Street 1:1646 MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5042
Mailing Address - Country:US
Mailing Address - Phone:318-443-9305
Mailing Address - Fax:318-443-3143
Practice Address - Street 1:1646 MILITARY HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5042
Practice Address - Country:US
Practice Address - Phone:318-443-9305
Practice Address - Fax:318-443-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1435198Medicaid
LA19-6622Medicare ID - Type Unspecified