Provider Demographics
NPI:1427343607
Name:LOUISIANA REENTRY & REHABILITATION SERVICES INC.
Entity type:Organization
Organization Name:LOUISIANA REENTRY & REHABILITATION SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:THEUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-614-1598
Mailing Address - Street 1:1116 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-2024
Mailing Address - Country:US
Mailing Address - Phone:318-325-1506
Mailing Address - Fax:318-325-1585
Practice Address - Street 1:1116 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-2024
Practice Address - Country:US
Practice Address - Phone:318-325-1506
Practice Address - Fax:318-325-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LASTATE LICENSE NUMBEROtherSTATE LICENSE NUMBER 331