Provider Demographics
NPI:1598344848
Name:INTENSIVE SPECIALTY HOSPITAL, LLC
Entity type:Organization
Organization Name:INTENSIVE SPECIALTY HOSPITAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSET MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-522-5970
Mailing Address - Street 1:1513 LINE AVENUE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4621
Mailing Address - Country:US
Mailing Address - Phone:318-425-4096
Mailing Address - Fax:318-424-2627
Practice Address - Street 1:1513 LINE AVENUE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4621
Practice Address - Country:US
Practice Address - Phone:318-425-4096
Practice Address - Fax:318-424-2627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder