Provider Demographics
NPI:1588899009
Name:LTAC HOSPITAL OF WASHINGTON- ST. TAMMANY LLC
Entity type:Organization
Organization Name:LTAC HOSPITAL OF WASHINGTON- ST. TAMMANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-269-9828
Mailing Address - Street 1:101 LA RUE FRANCE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3144
Mailing Address - Country:US
Mailing Address - Phone:337-269-9828
Mailing Address - Fax:337-234-1075
Practice Address - Street 1:621 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-4721
Practice Address - Country:US
Practice Address - Phone:985-732-4402
Practice Address - Fax:985-732-4708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA584282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19204600Medicare Oscar/Certification