Provider Demographics
NPI:1699116103
Name:REGIONAL REHABILITATION SERVICE
Entity type:Organization
Organization Name:REGIONAL REHABILITATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REHABILITATION THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:REHABILITATION
Authorized Official - Phone:318-359-6889
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:318 HILL ST
Mailing Address - City:EVERGREEN
Mailing Address - State:LA
Mailing Address - Zip Code:71333-0364
Mailing Address - Country:US
Mailing Address - Phone:318-359-6889
Mailing Address - Fax:
Practice Address - Street 1:318 HILL ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:LA
Practice Address - Zip Code:71333-0364
Practice Address - Country:US
Practice Address - Phone:318-359-6889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty